Interview with Dr Ben Harkin

INTERVIEWERS:
BEN SMYTH — COMMUNITY ENGAGEMENT PROJECT OFFICER
HENRY SUNDRAM — COMMUNITY ENGAGEMENT PROJECT OFFICER

Centre for cOMMUNITY cHILD hEALTH (CCCH) — THE ROYAL CHILDREN’S HOSPITAL

At the Centre for Community Child Health, we’re striving for equitable health and developmental outcomes for all children. The Centre has been committed to improving the lives of children and families for the past 25 years and we will continue to lead efforts to achieve equitable outcomes until this vision becomes reality.

The Centre provides leadership on the health and wellbeing of children aged 0–8 years. It aims to: 

  • improve development outcomes for Australian children;
  • advance equitable health for disadvantaged children;
  • and promote positive early life conditions for children.

Ben Harkin is a Fellow in Community Child Health, undertaking The Victorian Training Program in Community Child Health at CCCH. 

This program provides clinical and theoretical training in developmental-behavioural paediatrics. Fellows develop individual learning goals for the year, and are paired with mentors who have expertise in clinical practice, population child health research, public health and policy development, and program development and evaluation. Moreover, an emphasis is placed on clinical training that occurs within community and specialist outpatient clinic settings. 


What was your educational and career path like, and how did you eventually transition into medicine and paediatrics?

I had a very unusual path into medicine. I came to medicine much later in life as a mature-age student (early to mid-30s). Before that, I did a Masters of Public Health—which I embarked upon because I needed to do more tertiary education closer to applying for medical school and it seemed to be a logical thing to do. 

But prior to my Masters, I hadn’t done any science or anything in that field since I left school. I went to Melbourne University and did an arts degree, then as I had an interest in the performing arts, I auditioned for different drama schools in Australia and attended the Western Australian Academy of Performing Arts. Following which, I worked for about 10 years as an actor, director and producer. 

Then when I was in my early 30s, I was thinking about my future and what I would be doing in 10 years time, and I thought, ‘the thing I’m doing now, I’m done.’ And then I thought: ‘what am I going to do with the rest of my life?’ I rang some mates who were doctors and said, ‘I’m in my mid-30s, how do I become a doctor?  Is it possible?’ They said, ‘sure, you have to sit the GAMSAT and can apply as a mature age student.’’ So that’s what I did. Remember that it’s never too late to shift to something else and that skills you have in one career can also be transferred to other careers.

Being a doctor isn’t just having a knowledge base—it involves patient relationships, working in management teams and hospitals. 

I attended medicine at the University of Western Australia and they had a version of the course where we crammed in all the basic science stuff as a cohort of 60 mature-age students in seven months and then joined the undergrads in the clinical years. What was interesting about that cohort is that about a third of them were from non-science, non-medical backgrounds. 

For me and others who don’t come from a medical background, the first seven months were just crazy—it felt like my brain was exploding every day, getting around concepts like the Krebs cycle and biochemistry. But once we hit the wards and began clinical work, those of us who had non-medical backgrounds started to feel a bit better and do quite well because our patient interactions were influenced by our life experience.

The moral of the story is that if you would like to change your pathway, be aware that you bring a lot of different things to your practice as a doctor. Being a doctor isn’t just having a knowledge base—it involves patient relationships, working in management teams and hospitals.

What advice would you give to medical students who are unsure about which fields they would like to pursue? More generally, what advice would you give to those who are unsure about which career path to follow?

The experience of a med student is that you never know anything because you’re always being asked by someone who knows more than you. I remember saying to one of these senior people, ‘I’m so sick of just feeling stupid all the time’ and he said, ‘Don’t worry, that’s your entire life in medicine; there’s always going to be someone in the room who knows more than you.’

What’s interesting about medicine though is that there’s a niche for every personality type and interest; it’s so broad. Because of that breadth, it’s impossible to know everything about everything. People have different approaches to this: some people prefer a more generalist approach where they get to do a lot of different stuff and have a certain level of knowledge across a broad base, such as general pediatricians and general practitioners, and then other people like to drill down and know everything about a particular field and subspecialise. 

A useful thing to ask is: how does your brain work? Do you like to know a lot about a specific thing or do you prefer a more general approach? Then what type of medicine do you like to do: the kind of procedural-based, practical stuff; or more patient interaction? 

The other important thing is to look at other people in the career that you’re wanting to pursue. This applies to everything in life, but with medicine, certain personality types are drawn to certain specialties. But also those specialties create a world that encourages that personality type. You can look at the physicians or surgeons that are in the area of medicine you want to go into and think, ‘Are these my people?’

Find something that you’re interested in and talk to people who are in the field. What’s their daily experience? What are the good things and what are the crappy things about the job? Because there will always be good things and bad things. For me, before working in developmental paediatrics, I couldn’t quite find my niche in medicine. When I started working more specifically in developmental paediatrics, I kind of thought, okay, here are my people. This is where I fit.

This applies to everything in life, but just to talk about medicine: certain personality types are drawn to certain specialties. But also those specialties create a world that encourages that personality type. You can look at the physicians or surgeons that are in the area of medicine you want to go into and think, ‘Are these my people?’

What is your typical day like? Does it vary or do you have a particular structure that you follow? 

I’ll talk very briefly about a day in the hospital, which is not what I’m in now but what I’ve done for many years. As a junior doctor, you’re the one that often gets all the jobs done, you’re the engine that makes the team work. There are more senior doctors who are making management decisions and discussing with colleagues and deciding what investigations or other tasks might need to be organised by the junior doctors. They also coordinate the team and make sure everyone works well together. So that’s your basic nine-to-five day. There is also an after hours component in big hospitals, where you will be covering the care of patients from a number of teams that you may not necessarily be involved in on a day to day basis. 

The work I’m doing now is more outpatient-based and so I see kids and families from a range of cultural backgrounds with very complex social backgrounds, lower socioeconomic status and trauma. These kids may have developmental/behavioral difficulties such as delayed speaking, autism spectrum disorder, behavioral dysregulation, ADHD, a whole lot of things. Basically, if someone identifies a kid who’s at risk of not developing, they come to me for an assessment and I try to work out what’s going on. I have a couple of days in a community clinic, one day involved in cases where children have a background of Child Protection involvement and another day working with mental health services. 

So my current work is not about sick kids in the hospital. It’s not just getting them in, making them well and sending them home, it’s a much longer process. This is stuff where I see kids over months to years and try to slowly make improvements.  Since every kid’s different, each child is a bit of a detective case to suss out and a large part of that is working with the families to understand their experience, and the child’s experience within the context of the family, school, larger society.

What was your journey like through training and how have these experiences influenced your practice? 

For those readers who might be medical students, your exams are ongoing and you always continue to study and learn. Certainly, there are people in medicine who have incredibly bright minds and think in incredible ways, but there are also people who have different strengths. I don’t think you have to be a genius to be a doctor but you must be smart enough to know how to study and particularly be able to apply yourself consistently. One thing you need to get through medicine is to be able to persist because it’s a long slog. 

In order to work well in this area of medicine, you have to recognise the toll it takes, and be able to offload and accept that. This is an important part of your training. It’s very enjoyable, but it’s also very intense.

In terms of training once you have graduated from medical school, most of our basic pediatric training is geared towards acute medicine (although interestingly enough, many general pediatricians working in the community will not see these acute presentations). The first part of training is fascinating but also very challenging. There are certainly some difficult times along the way in terms of really hard exams you need to pass, challenging patients and family interactions, and really sick kids. 

Therefore it is important that you have people who support you and ways you can balance your working life. Certainly many of us have found ourselves at points where we feel burnt out. It used to be a problem that people didn’t want to address but now we are becoming more aware that, in order to work well in this area of medicine, you have to recognise the toll it takes, and be able to offload and accept that. This is an important part of your training. It’s very enjoyable, but it’s also very intense. Therefore, make sure you take care of your own mental health so that you can work and take care of others. 

Advanced training is where you become more specialised and where you try to become the type of doctor you want to be now that you have a solid foundation of knowledge. This is where you can work out what areas of medicine you want to work in. I’m currently a part of the Victorian Training Program for Community Child Health, which focuses on development and community pediatrics, which basically means I just get to play with kids all the time whilst assessing their development!

You mentioned that this year is giving you a chance to hone in on the areas you’re interested in. I was reading up on the training program and it said that the trainees set personal training goals, and they work with a mentor to realise them. So my question is how did you go about setting those goals and the mental challenges that were associated? 

One aspect is, you need to meet the training requirements. There are certain things you’ve got to tick off so some of those goals are about, ‘Okay, I need to do X, Y, and Z to make sure that I’ve done these specific things for these six months so that I’m accredited.’ 

Typically, minimum training time is probably about six years but most people spend more than that because you can’t really string everything together nicely. Often there are times within the training where you need to work in a particular area of pediatrics to progress but you might not be able to pick up the specific job to fulfil that requirement. So although you’re working as a doctor, it doesn’t necessarily progress your training. So you need to be setting goals and having your mentor keeping you on track to fulfil the training requirements.

Then the other consideration is more about what sort of things do you want to get out of your time? This is where you and your mentor get to have a bit of a philosophical discussion about life in medicine, what is your area of interest and how are you managing the work/life balance, because it becomes pretty all-consuming. That’s one of the biggest challenges that you’re going to talk to your mentor about. If you can, try in your current studies to find a really good way of working effectively and efficiently. It’s a great skill to have—the more efficient you are, the more downtime you’ll have in the future. 

It’s always important to remember that you’ve got a rotating roster of doctors in the hospital and part of that reason is so that people finish on time and can hand it over to the incoming team. So don’t feel that everything has to be perfect before you leave. Remember the perfect can definitely be the enemy of the good!

From your meetings with those more senior physicians and supervisors/mentors, were there any gems that you’ve incorporated into your practice?

That’s a great question. I think one of the things to remember about medicine is that you can’t know everything and what is important to know and the way in which you work  varies depending on the area of medicine you work in. So for working in an ICU or an ED, there is an immediacy to this area of medicine. There are emergencies that happen and you need to be able to react, and think quickly and efficiently. In lots of other types of medicine, particularly physician’s training, you generally have time to consider the options, research, and plan your approach. 

So a great bit of advice I got was recognising that you don’t have to have all the answers immediately. Often in medicine, you recognise that you’ve got some time to consider the issue and knowing how to get the information that you don’t have is the more important skill. 

Also knowing that you don’t necessarily need to be the one with all the answers. It’s important to remember that it takes a team to effectively manage a patient, whether that’s an acute medical team or in an outpatient setting, the best way to practise medicine is always in a team. 

If the lighting guy is asleep then the stage is dark and it doesn’t matter what you do as an actor, no one’s going to see you.

Forgive the comparison, but this parallels with a performance of a play. It takes a team. If the lighting guy is asleep then the stage is dark and it doesn’t matter what you do as an actor, no one’s going to see you. You’ll find that this applies to most aspects of life. 

Although one aspect of medicine is about acquiring knowledge and applying it to patients,  the other aspect is effectively communicating to both your team and the patient as well. So another gem is that as a junior doctor, the best residents are the ones who know how to communicate well and get stuff done. 

When it comes to medicine or any other career pathway, always try to find ways to venture outside your comfort zone and expand your thinking. I spent the last two years working in remote Western Australia in the Kimberley Region traveling to small Aboriginal communities. I had to adjust and reset my mind to working in clinics there. Adapting to these different environments definitely informed my practice and made me a better doctor. It was a great experience and I would encourage you to always find that opportunity to venture to greater depths because we grow by pushing ourselves to our limits.

Research or patient care: what should you do with a Biomedical degree?

BY STELLA LIU — DIRECTOR OF COMMUNITY ENGAGEMENT

Biomedical research is a high-impact field with large returns to society that merits consideration as a career pathway. Biomedical researchers endeavour to improve health by investigating how the human body works. Those who pursue this career pathway can find themselves in academia, where they improve tools and techniques, study healthy biological processes, and interrogate the causes and progression of disease. Others land roles in industry, which generally involves generating and evaluating treatments for human diseases and disorders, for commercial applications. Although the road to becoming a biomedical researcher is long and arduous, it is incredibly fulfilling and offers highly interesting work for the intellectually curious.


What is Biomedical Research?

Biomedical research can broadly be divided into several categories:

Improving tools and techniques

  • The process of conducting research is the crux of a biomedical research career, wherein there is a consistent need to improve current tools and techniques or develop new ways to understand biological processes. A notable example of this is CRISPR gene editing, for which Emmanuelle Charpentier and Jennifer Doudna were awarded the Nobel Prize in Chemistry in 2020. CRISPR is now commonly used to generate genetically accurate mouse models of disease, which has direct treatment applications.

Studying healthy biological processes

  • Knowledge of the most basic human processes, such as how cells function or how the immune system operates, is critical to the progress of biomedical research. University of Melbourne alumni Macfarlane Burnet is considered a scientific hero in this area. He developed the theory of clonal selection, which continues to serve as the foundation of immunology research. However, funding and support for this avenue of research is difficult due to ambiguous real-world applications.

Studying diseases and conditions of interest

  • Biomedical research primarily involves studying a particular disease/condition and the mechanics behind disease progression. This includes research to discover the causes of disease (e.g. bacteria, genetic mutation). Studying the interplay between diseases or conditions of interest and normal biological processes is crucial to determining treatment options.

Generating possible treatments

  • Knowing the cause of a particular disease/condition doesn’t guarantee that we will find an effective treatment. Generating treatment options can be based on knowledge of the disease/condition, but it can also rely on trial and error. For example, a promising approach to developing a new COVID-19 vaccine involves screening tens of hundreds of nanobodies to find one which can block SARS-CoV-2.

Preliminary evaluation of possible treatments (preclinical research)

  • Potential treatments are first examined “in vitro” outside of living organisms. This is an isolated environment which does not represent the complex interactions of a living being. Treatment options can then progress to the “in vivo” stage where tests are conducted on laboratory animals such as mice. This can recapitulate complex human biology, which gives valuable information about the effectiveness of a treatment before it progresses to clinical trial.

Clinical trials

  • Highly rigorous treatment studies are conducted in humans before a treatment can become widely available. Clinical trials come in different phases, with early phases being focussed on safety and later stages on the efficacy of the treatment. The goal of biomedical research is to generate information from the above categories and bring treatment options to clinical trials.

Why Biomedical Research?

Beyond the processes themselves, biomedical research offers the chance to make a tangible impact on society. Through research, we can offer significant improvements to health with a comparatively small investment of resources (time, money, effort etc). For example, it is estimated that reducing cancer deaths by 1% will save the US an estimated $500 billion. We are commonly exposed to organisations or events promoting support for biomedical research, such as Daffodil Day or MS Walk, but this can skew public perception of how research works. Research that involves studying foundational biology or improving research techniques is essential to treating these highly popularised diseases, but it can often be underfunded or understaffed. These “neglected research areas” have the capacity to offer massive returns in the form of quality adjusted life years (QALYs). For example, anti-aging research tackles issues such as cancer, neurodegenerative disease and cardiovascular disease from the foundation and aims to increase healthy lifespan. This is a far better approach to solving age-related deaths compared to mainstream research which typically promotes prolonging unhealthy lifespan. However, this is not as attractive for public funding or well-intentioned individuals who enter research to “cure cancer”.

Being a biomedical researcher is extremely satisfying, especially for anyone with a curious mind who is up for an intellectual challenge. Biomedical researchers spend most of their career doing self-directed work. Researchers, as early as Honours students, have the opportunity to work and direct their own project. They maintain their independence, creatively develop their own unique experiments and have substantial input on what they do. Furthermore, every day presents a new opportunity to satiate curiosity, whether that be investigating a new question, using different techniques or technologies, or collaborating with researchers across the world from different disciplines. The most successful researchers have intense intellectual curiosity, but also display high levels of resilience. Academia is highly competitive, and researchers must overcome setbacks, which can include a failed experiment or a rejected paper. A good researcher is also able to position themselves to build strong professional relationships and collaborations, which will help with securing funding, publishing ground-breaking papers in top journals, or working in the most prestigious labs. Although intelligence is important in a multitude of careers, it is particularly crucial for success in the interdisciplinary and complex field of biomedical research.

Good researchers are hard to come by, but without dedicated scientists and innovative minds, no amount of funding will solve the world’s most pressing biomedical issues.

Seeing as biomedical researchers often come from science or biomedicine degrees, medicine can be seen as an attractive career alternative which offers a similar intellectual challenge and a general sense of helping society. However, whilst doctors create a tangible impact in the lives of the patients they treat, they are limited in their ability to scale up their impact to match that of research breakthroughs or major policy changes. It is widely accepted that the “social determinants of health” (e.g. education, social-economic status) plays a far greater role in health outcomes than medical professionals do. Furthermore, doctors and health resources tend to be concentrated in areas of least need, a concept summarised by the “inverse care law”. As such, the incremental addition of an extra clinician into an oversaturated field has diminishing marginal returns. Shockingly, Dr Gregory Lewis from Cambridge estimates that an additional doctor will only add 4 QALYs for every year that they work, an impact which can be matched 30 fold by simply donating 10% of their salary to effective organisations that fight global poverty.

People likely to succeed in medical school have the potential to make a far greater impact outside medicine. 80,000 hours — an organisation which researches careers with the largest positive social impact — recommends that for those interested in medicine, the highest impact opportunities can be found in biomedical research. Good researchers are hard to come by, but without dedicated scientists and innovative minds, no amount of funding will solve the world’s most pressing biomedical issues. Dr John Todd, a Professor of Medical Genetics at Cambridge believes that “The best people are the biggest struggle. The funding isn’t a problem. It’s getting really special people” and would rather turn down substantial funds in exchange for a good researcher for his lab. This suggests that large grant options are still unable to attract top researchers, and that top researchers are more valuable than any state-of-the-art lab equipment purchased with grants. If you have the potential to succeed in biomedical research, this is a highly effective career pathway where you will likely have more impact than alternative pathways with the same degree.

Food for thought: Exploring the complex relationship between diet and health

BY SRESHTA SHERI — PRESIDENT

Food has long been a part of the story of humanity. Our relationship with food has changed in significant ways over thousands of years but perhaps the most dramatic changes have occurred only in the last 50 years. Food has gone from merely a means of survival to a key aspect of the human experience with a huge role in culture, comfort, and health. Even though diets hold a sacred space in the story of humanity, they may also be underpinning what is turning out to be one of the most destructive healthcare challenges of the modern era the rise of overweight and obesity.

Increased adiposity and obesity are increasingly linked to many other diseases such as type 2 diabetes, cardiovascular disease, and some types of cancer. The challenge that these non-communicable diseases (such as heart disease, diabetes, stroke, and cancer) present are vast and significant, representing a great burden on resources not only in Australia but across the globe, with the epidemic spreading to developing nations. Amongst the plethora of environmental changes that have arguably contributed to this crisis, a marked nutritional transition stands out.


Ancient Bodies in a Modern World  

In many ways, our bodies are engineered for a world of scarcity, now struggling in a world of abundance. Food scarcity was something we had to deal with for much of human history — every meal was crucial in ensuring our survival. It was in our biological best interests to be hard-wired to seek out calorie-dense foods and optimise our fat storage for times of food shortage. It was not unusual for humans to go without food for long periods of time throughout much of human history. Our biology has evolved over thousands of years to optimise for this food scarcity by having metabolically advantageous genetic adaptations that allow for the deposition of fat as an efficient store of energy.

However, the past 50 years a blink of an eye in evolutionary terms have seen significant changes to our diet in industrialised economies. The presence of ultra-processed, high fat, high sugar foods is ubiquitous and worryingly accessible. Bodies that were fundamentally wired for scarcity are today placed in a world of full fridges and pantries. With the effects of increasingly sedentary lifestyles compounding the problem, poor diets have arguably wreaked havoc on human health. Two-thirds of our nation’s adults are overweight or obese and the challenge of non-communicable diseases is one of the biggest burdens on the healthcare system. Our bodies being out of their depth in this modern food landscape only scratches the surface of this problem the challenges of the ‘obesogenic’ environment are underpinned by economic, political, and sociocultural factors that are deeply ingrained in our society.

In many ways, our bodies are engineered for a world of scarcity, now struggling in a world of abundance.

How did we get here? 

The obesity epidemic is more than just a diet problem, it is a deeply rooted systemic issue that plagues the lower socioeconomic classes. Increased adiposity and obesity are diseases that disproportionately affect those in the lower socioeconomic classes. From a nutritional perspective, the lower socioeconomic classes are often deprived of access to affordable, fresh, and nutrient-dense produce whilst being inundated and often targeted by fast food and unhealthy options which may be the only options in some cases.

Big Food (corporate food and beverage companies) represents some of the most powerful and destructive entities in the world when it comes to public health. Funding scientific research, financing political campaigns, lobbying, and financing campaigns are some of the ways in which these large companies yield their power. Ultimately, the problem with our diets is hardly an individual one it is deeply intertwined with political, social, and economic factors that need to be considered. 

Where to from here?

The future presents significant challenges not only for our diets, but food sustainability globally. By the year 2050, we will have 10 billion mouths to feed. Rethinking our global food system will be inevitable as new challenges emerge concerning agriculture and sustainability. From a health perspective, addressing our diet is perhaps one of the most important issues to tackle in the journey towards a healthier human population and reducing the burden of non-communicable diseases. The sociological challenges are many in this arena, but huge strides of progress continue to be made nonetheless. From huge changes such as the plant-based movement to the work of grassroots organisations that are involved in health promotion, fixing our diets is a shared responsibility that must be championed for a healthier society.

Pathways to achieving SDG 3

BY BEN GRIFFITHS — COMMUNITY ENGAGEMENT PROJECT MANAGER

The world is simultaneously facing both a climate crisis and the harsh reality of global poverty, both of which require urgent action from all of us to resolve. However, pursuing one goal — either ameliorating global poverty or combatting climate change — can often involve exacerbating the other. For example, the Global South pursuing the fossil-fuel based industrialisation and development paradigm of the Global North would cause devastating global warming. The inverse can also be true, wherein aggressive climate change mitigation policies can stifle the growth of low-income countries and deprive their governments of the tools necessary to alleviate their citizens from the deprivations of poverty. Given the urgency and extreme consequences of both issues for sentient wellbeing, compromising on either the planet or human development is fundamentally undesirable.


SUSTAINABLE DEVELOPMENT (SD)

This dilemma has created the impetus for the sustainable development movement, defined by the 1987 Brundtland Commission as ‘development that meets the needs of the present without compromising the ability of future generations to meet their own needs’. Critically, this movement addresses the intertemporal dynamics of human development and climate change, which is often characterised by a tradeoff between meeting the present development needs of the current generation and mitigating the future ecological and sentient damages of anthropogenic climate change. The sustainable development movement has culminated in the establishment of the 2030 Sustainable Development Goals (SDGs), which includes 17 goals to be achieved by 2030 that represent ambitious targets for holistic global improvements in development, while aiming to be compatible with the current ecological crisis. 

Overcoming this intertemporal challenge — and hence achieving sustainable development — represents a substantial task that requires intelligent policy and action at all levels of society. Meeting the global and systemic needs posed by the SDGs is unlikely to be achieved by a single hero or actor, purely by their nature as ‘wicked problems’. Wicked problems are complex and multifaceted issues with no simple solutions, thus necessitating substantial resources, time, commitment, and collaboration from a range of stakeholders. This can and should include intergovernmental organisations, NGOs, national governments, the private sector, civil society, communities, and individuals. Not only do these crises necessitate this level of collaboration (even if some approaches place disproportionate emphasis on particular stakeholders), but the collaboration itself is an opportunity to mobilise whole-of-society responses towards unified goals, thus building solidarity and the collective infrastructure to face other similarly global problems.

CRITIQUES OF SUSTAINABLE DEVELOPMENT

As with any idea, it’s important to engage critically with sustainable development to assess its merits and improve or alter its scope, application, and framing accordingly. 

Given the simple and broadly applicable nature of SD, a degree of ambiguity can result wherein SD and its composite terms have a variety of competing definitions and framings. Failing to agree on a coherent and consistent definition of a framework has practical implications in contexts such as the thresholds for what constitutes a “sustainable” environment or which metrics should be employed to evaluate “development” progress. 

Should a local council build a community centre, homeless shelter, family planning clinic, or preserve the existing environment on a block of land? Should a low-income country pursue manufacturing-led industrial policy which has been demonstrably effective even though it results in greater emissions?

However, it is nonetheless important to create space for diverse and critical perspectives with the understanding that development is not a “one size fits all” phenomenon and solutions need to be contextually specific and culturally appropriate. SD doesn’t necessarily capture this need in its mainstream application, as many of its core tenets are rooted in narrow eurocentrism, such as the dichotomisation of society and nature, which contrasts with cultures that adopt a more integrated view. This has led to the creation of alternative frameworks such as ‘buen vivir’ in Latin America and greater pushes to improve the inclusivity of SD. 

Beyond the above concerns, SD has been critiqued for being limited on the basis that it doesn’t engage with the notion that a more fundamental disruption to the economy may ultimately be necessary. This also extends to the lack of embeddedness of structural critiques made by postcolonial and feminist thinkers regarding power dynamics or the focus on agency and individual freedoms made by Amartya Sen. While attempts have been made to incorporate these views within SD, it is apparent that further work is required to refine SD. Moreover, it is critical to recognise that SD is not an exhaustive framework, which necessitates an approach whereby SD is used in conjunction with structural considerations alongside varying approaches and lenses.

There are also some more practical concerns within SD that warrant further consideration. For example, SD doesn’t address how to prioritise goals when contradictions emerge. This necessitates broader social conversation about how to make this prioritisation in either a general or contextual basis. Many scenarios will result in some objectives being hampered or neglected by pursuing others. Should a local council build a community centre, homeless shelter, family planning clinic, or preserve the existing environment on a block of land? Should a low-income country pursue manufacturing-led industrial policy which has been demonstrably effective even though it results in greater emissions? These tangible concerns among others have been responded to by either developing heuristics and principles such as ‘polluter-pays’ and the ‘precautionary principles’ or through building agreement within specific contexts. The latter approach seeks to build best practice on a per-issue basis such that solutions are contextually appropriate.

Given these issues and various responses to them, it’s important that SD is ultimately seen as a discourse wherein further conversations about framing, implementation, and competing perspectives can be found.

SDG 3

Source: Our World in Data, Healthcare Access and Quality Index, 2015
Source: Our World in Data, Death rates from air pollution, World, 1990 to 2017

In order to further explore the SDGs and evaluate progress towards them, SDG 3 (Good health and wellbeing) will be analysed given that it is a relevant objective for Strive as an organisation, as well as students in the public health space. SDG 3 aims to “Ensure healthy lives and promote well-being for all at all ages”, involving 13 ambitious health-related targets, and is measured using 28 indicators. These targets range from reducing maternal and child mortality, fighting communicable and non-communicable disease, to preventing and treating substance abuse. These represent broad and effective goals that target a range of health outcomes, including requirements that all countries must pass to ensure that equitable and just progress is achieved. 

Inclusive institutions are progenitors of development, climate change has the potential to wreak havoc on global health, and the equitable nature of the targets makes them impossible to achieve without resolving inequities.

Tracking the achievement of this goal is a monumental task itself, requiring comprehensive and consistent data collection across every single country. Many of the indicators have data available for them, but there are a few without any high-quality data sources, and many regions of the world — such as sub-saharan Africa — consistently lack high-quality data for most indicators. This is a reflection of ongoing data inequality issues that impede the ability to evaluate and create targeted development initiatives. Within the purview of these limitations, steady progress has been made across most targets before 2020, such as maternal and infant mortality, life expectancy, sanitation, malaria, as well as HIV/AIDS reduction. However, much more progress is required to reach the targets by 2030. The need for greater progress has been magnified by the onset of the COVID-19 pandemic, which has directly created additional health problems. This then creates downstream health effects by reallocating health resources to combating a pandemic, while exacerbating substance abuse, mental health, and domestic violence due to the need for lockdowns and the ensuing economic recession. The combination of these factors alongside the disruption of medical supply chains has been a devastating blow to the achievement of SDG 3 amongst others, which requires immediate and substantial long-term action to alleviate and propel the global community towards greater public health. If you would like to further investigate SDG 3 as well as progress towards the other 16 SDGs, Our World In Data has a comprehensive and open-source SDG tracker that uses high-quality data to evaluate progress towards each goal.

It is also worth emphasising that each goal has not been designed as a set of discrete objectives, and that there are important interrelations and causal chains between SDGs, such that there are co-benefits to achieving any particular goal as well as to encourage holistic development. This can be seen in the context of SDG 3, where achieving goals such as eliminating poverty (SDG 1), zero hunger (SDG 2), and clean water and sanitation (SDG 6) result in greater health outcomes. This is a two-way causal link given that these goals themselves improve as greater health outcomes are achieved. Interrelations extend beyond bi-directional causality, as goals such as climate action (SDG 13), reducing inequality (SDG 10), gender equity (SDG 5), and strong institutions (SDG 16), serve as prerequisite foundations for meaningful health outcomes to be achieved. This is because inclusive institutions are progenitors of development, climate change has the potential to wreak havoc on global health, and the equitable nature of the targets makes them impossible to achieve without resolving inequities. This underscores the importance of an approach that targets all goals simultaneously, so as to achieve the desired metrics, which are ultimately reflective of lived human experiences that need to be improved in a multidimensional way. 

How can we achieve SDG 3?

The COVID-19 pandemic has reinforced the importance of public health and the need for global collaboration in a time where many nations and people fragment and turn insular. The next 10 years of progress towards SDG 3 will need to be characterised in the context of amending the long term damages of COVID-19, both in terms of public health and the global insulatory effects of quarantines. 

Governments and IGOs will need to focus on the disproportionate effects the pandemic has brought upon already marginalised groups and low-income countries, while reestablishing and building upon development programs that were sidelined in 2020.

The private sector also has a role to play, with the healthcare industry and adjacent sectors being of particular importance, not just to SDG 3, but to each goal. The SDG industry matrix team produced a report outlining how the healthcare and life sciences sector can contribute to each SDG, via the principles of preventative healthcare, healthcare resilience, universal health coverage, and environmental sustainability.

Civil society and activist groups are critical elements for the democratisation of SDG negotiation and policy, through having the capacity to apply pressure and bring perspective to large and powerful stakeholders. These groups are also essential to mobilise the general public to be aware of and engage with SDG implementation.

For the sake of brevity, there are many other important stakeholders that can contribute towards SDG achievement or minimise their own harm such as industry associations, individual health professionals, and community organisations. It is through these stakeholders that extensive collaboration will be required to mobilise the whole-of-society response necessary to achieve the SDGs, including SDG 3.

What can you do to achieve SDG 3?

We live multidimensional lives and our impact should reflect that. There are numerous contexts and spaces that we occupy that can be mobilised for positive social change. Below are examples of how you can use your resources, social circles, student status, political lives, and future careers to contribute positively to the achievement of the SDGs. For a more comprehensive look into the multidimensionality in our lives, I have written a previous article about making an impact in the face of climate change.

As a student:

  • Take development and sustainability electives
  • Involve yourself with student organisations that contribute towards the SDGs such as Strive, MUHI, Melbourne Microfinance Initiative, Enactus, model UN society, and many more
  • Engage in student politics and university SDG initiatives. For example, the University of Melbourne does not currently feature on The Times Education’s university SDG performance ranking and it’s incredibly important that we encourage the university to feature in these evaluative initiatives and contribute more meaningfully
  • Take your time as a student to learn and engage yourself with various facts, experiences, and perspectives in an open and empathetic way

As a professional:

  • Pursue careers that directly advocate for or contribute to the SDGs
  • Encourage your workplace to adopt more sustainability initiatives
  • Contribute to the SDGs through a side hustle or social enterprise

Using your resources:

  • Divest from fossil fuels and companies that contribute negatively to public health
  • Donate to effective organisations that are SDG oriented, and meet high standards
  • Volunteer your time for positive social causes
  • Make more socially conscious consumption decisions and live a low GHG emissions lifestyle (plant-based diet, use public transport, minimise waste, use renewable energy when possible)

As a political constituent:

  • Attend peaceful and socially responsible protests
  • Factor public health, climate change, and development into your voting decisions
  • Attend community meetings and contact your local representative to achieve SDG alignment in your community
  • Run for office on an SDG-oriented agenda

Beyond these tangible actions, it’s equally important to raise awareness and have conversations about these issues with your friends and family. Moreover, forming social groups that care about these issues will help to build a sense of community, while ensuring that your contribution is more engaging, fun, effective, and manageable. It is only with a large coalition of informed and engaged people that we can overcome global issues together and build a better future for everyone.

Strive’s Teams — Looking Forward

Hear from Strive’s Program Managers as they shed light on their teams’ exciting and impactful projects for Semester Two. We’re excited to see you at our events and volunteering opportunities!


Strive Conference

A photograph from Strive’s Annual Conference in 2018

The Strive Conference is an annual event that captures our core values of health promotion and education via a panel with key leaders in the public health ecosystem and a case competition on a pertinent public health issue. For the first time, Strive is excited to announce that we will be collaborating with Melbourne University Health Initiative and 180 Degrees Consulting Unimelb on the case competition aspect of Strive Conference 2021!

The Global Health Case Competition (GHCC) will be an interdisciplinary case competition, involving students from multiple faculties, where participants will be prompted to provide a solution to a case study. This year, we aim to provide a case study that focuses specifically on the youth mental health crisis and the mental wellbeing of University of Melbourne students.

We look forward to seeing you at the GHCC workshop on the 6th of September and Finals Night on the 16th of September!

Make sure to stay tuned via our Facebook page for more information and updates regarding Strive Conference 2021.


University Engagement

The University Engagement team aims to promote wellness among our peers and local community through informative speaker sessions and interactive activities. Our goal is to create an environment to encourage healthy lifestyles within the campus community, improve health literacy on campus, and create an environment for students to meet others who are passionate about public health topics. During Semester 2, we have planned many exciting activities for students, such as a trip to Queen Vic Market and a speaker session about health literacy during COVID-19. In addition, we hope to increase campus awareness of Strive’s initiatives and find some amazing speakers for the case competition!

Brianna Heinken

My name is Brianna Heinken and I’m currently a 2nd year Bachelor of Biomedicine (Neuroscience) and Diploma of Languages (Spanish) student at the University of Melbourne. I’m passionate about health literacy, policy-making, mental health, and making an impact in the lives of others. In my free time, I like to get active outdoors, spend time with family and friends, explore the world, and read books. You can catch me around campus and I’m always ready to have a chat about our University Engagement initiatives or public health!


Publications

The Publications team is responsible for creating publications that inspire students while empowering them with the knowledge and awareness to contribute positively to global public health. So far we’ve achieved this via the creation of Regimen: Striving for Global Health, of which you are currently reading an article within Edition 3. Each edition so far has featured articles written by our committee, and interviews with leading public health professionals. Topics have ranged widely, including explorations of pediatrics, advice for students, climate change, equitable vaccine distribution, and personalised medicine. This semester we look forward to continuing to publish Regimen while writing the case study for the GHCC.

Ben Griffiths

My name is Ben Griffiths and I’m currently a 4th year Bachelor of Commerce (Economics) and Diploma in Languages (French) student at the University of Melbourne. I’m passionate about policy, public health, climate change, international collaboration, and finding ways to combine these interests to make a tangible impact. In my spare time I like to play guitar, learn more about the world, hang out with friends, and write articles. You can find more of my current and previous writing at Cainz, ESSA Unimelb, Melbourne Microfinance Initiative, and LSE International Development Review.


Storybook

The Storybook team aims to promote healthy-eating associations within preschool children through the creation of a nutrition storybook, and provide parents with an easy-to-read and accessible resource on nutrition and meal prep. We have also been working on virtual COVID-19 health & hygiene and physical activity workshops. During Semester 2, we are working on translating the storybook to three predominant languages in Melbourne (Mandarin, Arabic, and Vietnamese), disseminating the workshops to primary schools, and creating an in-person format of the health & hygiene workshop for use after the pandemic. Additionally, we hope to engage in more team building activities and partake in the Strive case competition! 

Shanaya Ramchandani

Hi! My name is Shanaya Ramchandani and I am a third-year Bachelor of Biomedicine student, majoring in Pharmacology. I am passionate about medical research, in particular cancer pharmacology (have published four peer-reviewed papers), mental health treatment and neuropharmacology, as well as infectious disease treatments. I have also been heavily involved in charity, and outside university, I run a non-profit clothing initiative based in Singapore, called wear:change, consisting of fifteen team members. I am also an Indian Classical Dancer, and enjoy painting, cooking, cocktail-making, and hanging out with friends during my free time! 


Nutrition Initiative

Semester 2 will see the fruition of the Nutrition Initiative’s in-person workshops. Our main focus will be delivering workshops to schools in north and west Melbourne. We aim to host 1 workshop per month and adapt our program as we go. We are fortunate to informally partner with Sanitarium Australia, who have generously donated resources to support our workshops. It is very important for us to collect feedback through post-workshop surveys so we can achieve this goal. We also hope to refilm our video workshops, which the film from our first attempt was unfortunately corrupt. However our primary focus is the in-person workshops, hopefully running 6 times throughout semester 2. 

Jessica Louise Parry

Hi there, my name is Jessica Louise Parry and I manage the Nutrition Workshop initiative of Community Engagement at Strive. My interest in nutrition science and education is what propelled me to apply for project management with Strive. I am currently a Masters student researching vitamins in plants with mass spectrometry. I am really excited to apply my research when teaching nutrition to children.


University Engagement

The University Engagement team aims to promote wellness among our peers and local community through informative speaker sessions and interactive activities. Our goal is to create an environment to encourage healthy lifestyles within the campus community, improve health literacy on campus, and create an environment for students to meet others who are passionate about public health topics. During Semester 2, we have planned many exciting activities for students, such as a trip to Queen Vic Market and a speaker session about health literacy during COVID-19. In addition, we hope to increase campus awareness of Strive’s initiatives and find some amazing speakers for the case competition!

Brianna Heinken

My name is Brianna Heinken and I’m currently a 2nd year Bachelor of Biomedicine (Neuroscience) and Diploma of Languages (Spanish) student at the University of Melbourne. I’m passionate about health literacy, policy-making, mental health, and making an impact in the lives of others. In my free time, I like to get active outdoors, spend time with family and friends, explore the world, and read books. You can catch me around campus and I’m always ready to have a chat about our University Engagement initiatives or public health!


Strive Clinic

In Semester 2, Strive Clinic is looking to strengthen our relationship with Bolton Clarke and deliver more CPR workshops to elderly people across the country via Zoom, and hopefully have an in-person session so we can make it as interactive as possible! We’ve received feedback that the workshops (that are run by students from multiple disciplines) are highly valuable and informative for the recipients so far! 

In addition, we also look forward to attending the Avalon Centre drop-in sessions again once COVID allows, and get back to providing basic health check-ups and wound care for people who come by, whilst also providing our student volunteers the opportunity to refine their skills. 

Finally, we hope to help out those applying for medical school by running our annual mock MMI workshops! That will be coming up soon so stay tuned.

Audrey Lui

Hello! I’m Audrey, the Director of Clinic for 2021. I first got involved with Strive in 2018, as much of Strive’s mission aligned with my interests—promoting health literacy and improving access to healthcare in the community. As such, I am also involved in volunteering outside of uni as well as various clubs within uni. I’m currently a 2nd year medical student and I really hope my extracurricular experiences and lessons can enhance my interaction with patients as well as colleagues in the future!