[Auto-generated transcript. Edits may have been applied for clarity.] Well. Welcome everyone this evening. Thank you all for coming and thank you for people online and in person.
Um, thank you for joining us. Um, we're focusing today on why sustainability and health care cannot be implemented.
Intriguing. Thank you for asking. So why this lecture?
Um, well, so my name's Tom Shaw. I'm professor herring.
Uh, also, and I lead a course on sustainable health care that we've been delivering all week.
And the course is part of the MSC program in translational health science.
Uh, with much learning across the course about how things get into practice or in general, how they don't.
Um, so I think we're at a crossroads at the moment in terms of sustainability as health systems.
Um, should be 4 to 5% of greenhouse gas emissions.
Um, we know that this impacts significantly on health and environment.
So things need to change urgently. Um, but it's not happening as quickly or the scale that many of us would like.
Um, I think the question before you that today, while many questions actually um, but is why?
Um, so this is exactly what even just going to focus on.
Or I hope you can focus on why sustainability and health care cannot be implemented.
And you're taking a specific scale as well. Um, um, so I have a brief introduction to agents.
Um, is professor of interdisciplinary health science at the University of Oslo.
Um, an awful lot more. Um, and you bring a background in medical humanities, which is very welcome.
It's not something that we've particularly touched on this week, so we're definitely looking forward to very light.
Are you guys? Research explores how medical knowledge is generated, applied, documented, evaluated,
and communicated in clinical encounters and wider societal context as well.
So he brings a very welcome and in my opinion, very much needed a critical perspective and an interdisciplinary lens, uh, to sustainability.
So we're very much looking forward to what you have to say.
I'm also very happy to introduce Trish Greenhouse, um, who is going to be acting as discussant today.
Uh, so that was really formally I know you can reply and maybe you.
Um, so she's professor of primary health care here in Oxford. Um, but also much more.
Um, Trish is also program director for translational health science.
Um, so the program that sustainability sits in and I think open interest to, you know, each other and work together quite a bit over the years.
Um, so I think we're looking forward to what both of you have to say and that dynamic as well.
So the plan today is I think you're going to talk for 45 minutes or so, and I know you have some slides, um, for people who are online,
we've chosen to really put avians in the foreground because although your slides are important, they're not critical.
Um, so I hope you'll forgive us if you can't see the detail of the slides,
but you will get the detail of what is also going to say, the slides and the background.
And then, Tricia, I think you're going to respond for 5 or 10 minutes up in the air.
Um, and then we're going to open for wider questions and discussion for the question.
So I was up and over to I. Thank you so much, Sara, for, uh, for your introduction.
And it's lovely to be here and beautiful Oxford in the inbox and then fantastic to be invited to this amazing force that you all are organising,
which I really think is quite unique.
And we're very lucky, uh, students, to be here, to be part of this and, um, and also the program that it belongs to.
Uh, I'm going to talk about the problem of implementing sustainability, uh, in health care.
And, um, I'm going to raise the question,
potentially provocative question of whether implementation is the right solution or the right language or the right grammar.
Uh, when it comes to sustainability, uh, in healthcare.
After decades of policies and plans for sustainable health care, we keep hearing that we have failed to implement sustainability.
We have. We have blueprints. We have evidence. We have global agreements.
We. We have national strategies. But environmental conditions and health inequities remain stubbornly dire.
And the usual explanation of this is an implementation gap that somewhere between policy, design and practice, something goes wrong.
And we blame weak execution and lack of political will and insufficient buy in.
In short, we we blame a failure to influence.
And in fact, in a, uh, it's a systematic review by House and colleagues shows that this, this diagnosis dominates the field.
But failures to achieve environmental sustainability are dominantly framed as failures of implementation,
attributed to structural constraints and so-called variance in the system.
And across 94 studies.
Uh, this review shows how this framing repeatedly redirected attention towards economic, political, and administrative obstacles,
reinforcing implementation failure as the default explanation for unsustainable outcomes, rather than questioning underlying policy assumptions.
Underlying policy goals. I will invite us to look at this differently.
I will argue, then, that sustainability in healthcare cannot be infinite.
Not because we lack initiative, but because implementation is the wrong way to think about sustainability in the first place.
Sustainability is not a tiny program to be that can be rolled out from headquarters.
It is contested. It is a value laden.
It is an on the ground practice.
And. Treating. And that is my point.
Treating sustainability then as an implement, as an implementable technical project or program.
It's a category error. It mistakes a living relational process for static filtering.
And in doing so, also I log you in inadvertently confuses the very failures that we intend to solve.
This is, of course, not to say that all sustainability efforts in health care being pointless.
Absolutely not. And nor do I suggest giving up on sustainable health care.
Uh, far from it. You need a sustainability centre and also a focus.
I want to propose a shift in perspective.
From seeing implantation failure, I think.
Yeah. To be close to seeing these so-called failures as signals that sustainability is
something fundamentally different from what our implementation ground assumes.
So instead of asking how we can implement sustainability, we might ask,
what if sustainability is already happening, just not in the forms that our policies expect?
So by the end of this talk, I hope to convince you that sustainability and health care is always already unfolding.
Three community initiatives everyday practice and self-care, and even through disagreement about values and about priorities.
So. The task, then, is not to enforce a grand plan,
but to recognise and to engage with and to empower the forms of sustainability that are already in motion.
And doing so requires a fundamental rethinking of our policy framing of sustainability to think about
the UN Sustainable Development Goals that cost sustainability and universal metrics and indicators.
And on a theoretical level it means trading the comfort of implementation checklists.
For the more demanding work of ongoing mediation, ongoing translation, and ongoing negotiation.
So let's start by examining, uh, what we imply or what we implicitly assume when we talk about implementing anything.
And in health policy implementation science defined as the scientific study of methods to promote
the systematic uptake of research findings and other evidence based practices in routine practice.
Emerge, uh, at least largely from the evidence based methods and movements, and it relies on a sequential, structured approach to change.
Typically, this approach begins with designing a clearly defined intervention optimised to reflect evidence,
then testing it on pilot settings and finally scaling it up or rolling it out widely by identifying and overcoming solver variants for optimal.
And this quite linear model, uh, rests on several strong assumptions.
And I love, like some of them. Uh, it assumes that.
There is a stable object. But there is a well-defined intervention or program to be implemented.
It assumes that. There is a clearly defined problem, but the but the problem the intervention addresses, it's agreed upon more or less.
It assumes that stakeholders have shared uncontested goals and that the desired outcomes are more or less the same for everyone.
I think it assumes a linear timeline that changes occur in an orderly sequence from evidence to intervention,
to scale up with clear start and end points.
And finally, it assumes a central authority legitimate authority such as scientists, experts,
policymakers are in place to steer the process from evidence to design to execution and when outcomes.
Else falls short. Failure is therefore located in execution.
Understood as some kind of breakdown somewhere along the the the chain from from from evidence to to action.
Now consider sustainability in healthcare.
It actually violates all of these voided assumptions.
What exactly is the object of? Oh, sustainability.
You will notice that I will play around with the object of sustainability.
In this talk I will broaden length, uh, because, uh, the object of, uh, of sustainability changes.
Uh, are we trying to sustain patient health, community well-being, art, environmental resources, health care systems?
All of these, of course. And sometimes the those aims, they come right in one another, like open.
They conflict with one another. And what are the problems that we are solving with sustainability?
But that depends on who you ask. Is it climate change?
Is it health equity? Is it resource sparsity?
Is it future pandemics? The problem definition is plural and framed differently depending on or on the stakeholders.
And then we both. The goals of sustainability are deeply value laid and often contested.
One group's vision of sustainable the sustainable future may not align with another's.
And then timeline. Sustainability resists.
In a neat linear timeline. It isn't as one of intervention with a clear start and finish.
It is an ongoing balancing that unfolds on multiple time, uh, horizons simultaneously.
At times, it demands rapid crisis responses, such as during a pandemic, uh,
while at others it requires slow patient work like prevention, capacity building, environmental stewardship.
And these different temporalities. They sit uneasily in models that assume that change follows a single tiny one.
And then finally authority. Authority and sustainability is likely conversely.
So government agencies, local communities, frontline workers, indigenous elders,
future generations voiced by various advocates all have claims to decide what sustainability should mean and how to achieve it.
So there is no uncontested authority who can simply decree what we should do.
So given these realities, when a sustainability initiative fails to be implemented, uh,
at least in the conventional sense, it isn't necessarily because we people were in effect or uncooperative.
More often it is because implementation was the wrong grammar for the task.
We tried to fit a dynamic social process into a linear delivery model.
It's like trying to find a screw. It's the tool doesn't match the material.
And the result is frustration on all sides. Policy makers sees non-adherence from Unity's the top down imposition and everyone sees low level.
And then importantly, labelling something as an implementation failure.
That is not neutral language. It's not unusual diagnosis.
It is packed with politics. And this language, uh, often recasts legitimate persistence or pluralism or contestation.
Uh, as dysfunctions. Think about it.
When local actors, uh, question the goals so of, uh, of the sustainability plan, it is often labelled as a lack of buying.
Or when they advance alternative values, they are written off as barriers or if they proceed as a careful,
community defying pace, it is dismissed as city failure or outright refusal is branded as an irrational resistance.
So under the failure to implement story that the storyline,
the problem and that is the point cannot be the concept of sustainability as it is defined from about.
The problem must be the people below who just get with the program only.
And the spotlight therefore shifts away from possible flaws in policy, design and choice.
Instead, don't just supposed efficiency so implemented so of communities of the two section.
And this creates what we have called a paradox of the of unemployment, the ability.
Uh, by framing the situation as the failure of execution,
the dominant narrative ensures that implementation will remain impossible because it has misdiagnosed
the social or the complex social negotiation as a simple technical rollout of the program.
We often hear about, uh, the policy action gap.
But, you know, that chasm between, uh, lofty strategies and the on the ground realities.
But instead of viewing that gap as an empty space, uh, or it kind of a void of failure,
we should see it as a fertile space of translation and mediation.
It is not a vacuum. It is a busy workshop.
It is a stone or in this soul, global or a national.
Ideas about sustainability need local words, and neither of these, in the much unchanged knowledge is being venerated.
Values are being be evaluated and authority is being renegotiated.
And this is where sustainability still lives.
Not in the science. Uh, on the bond paper.
So when the policy document says sustainability.
That word only becomes real as people sleep it.
As people argue over it. As people try different things out on the ground related to it, that is when it becomes real.
The knowledge in the plan doesn't exist as a fully formed entity or context independent unit entity.
Before this translation, the planner grand idea is not self-executing.
They become concrete and meaningful only through practice and negotiation in real world settings.
So in other words, sustainability doesn't really exist the process of translating it into practice.
It is not an origin that precedes action, but an outcome for continuous inaction.
We only know what sustainability really means in a given situation by seeing how people continuously will make it in.
This is why I argue for a translational humanities approach to sustainable health care,
uh, which I, uh, have introduced, uh, distinct from translational science.
But sensational humanities, I mean, approaches that pay attention to narrative convening and interpretation in processes of change,
much like marathon medicine at the bedside. But, uh, applied to policy and implementation.
And these perspectives are crucial because sustainability efforts.
They failed. When we treat trans translation as just a technical afterthought.
If we assume that the facts and solutions are clear and we just need to deliver them to the recipients,
we know how meaning gets shaped, how it gets bent and warped in that delivery.
A translational humanities perspective therefore reframes implementation as interpretation.
And it triggers us to ask other questions, such as whose story is being told as the solution here, whose values count as legitimate evidence.
What gets lost and added or transformed as we move ideas from from one context to another,
little bit like we do when we when we translate a message from one language to another.
In other words, it's it. It forces us to see hidden narratives and value judgements that are embedded
in our politics and in our arguments to make it a little bit more concrete.
Implementation science often talks about various barriers to occupy.
But many of these so-called barriers. What are they really?
They are, in fact, alternative narratives. They are alternative moral wells that do not necessarily align with the dominant script.
Perhaps the community is a bit bracing for a sustainable technology because
that technology conflicts with their with their sense of life or well-being.
And from a translational humanities standpoint, that is not just to stop.
And better yet, it's meaningful difference in worldview that deserves acknowledgement, that deserves understanding and and dialogue.
So what looks like resistance through a narrow lens, uh, can be reframed as an interpretive supplement.
And that reframing opens new questions. What can you learn from this resistance?
What values are truly at stake here? How might that policy be translated or adopted?
Just speak to those. Values.
There is no need blueprint that will make everyone see sustainability the same way.
And if they wesker's blueprint, we should definitely be suspicious of it.
Instead, we need to, uh, we need practices that allow ongoing negotiation without declaring one side simply fail or innovation.
And this means fostering spaces where multiple narratives about sustainability can coexist and be debated openly,
rather than enforcing a single dominant narrative.
Some translational humanities approaches challenge a kind of dominant linear model of knowledge translation.
It reminds us that medical knowledge is not a stable practice to, uh, or any other knowledge for that matter.
It's a stable package that can be shipped and tracked from research to to practice.
Knowledge becomes real when it is woven into stories, values, contexts.
That's that targeted audience. So translating evidence into practice is nothing like plugging in the USPTO or rival facts.
It's more like telling the story. It's a story that most resonate with.
I think they resonate with those who hear it. And it's the story clashes with deeply held values or experiences.
It will be rejected no matter how evidence based it is.
But even more important, uh, for my talk, is that sustainability doesn't begin when a new policy is rolled out.
It is always underway in countless grassroots practice.
Sustainability. This is not the this end state we will reach once we have finally implemented everything properly.
It is something that people are doing right now, often invisibly and often in spite of official plans.
So if there is one message you take away, take away from this.
Let it be this that sustainability is always already just not as a standardised program handed down from above.
It is a situated, contested, ongoing process and practice.
And what does this mean? It means that when other people are.
Rattling and I have been I, I'm using sustainability deliberately in a very, very broad sense.
It. But it means that when other people are grappling with how to live and find care within constraints,
within constraints, be those constraints environmental,
social, economic, and when they need to live and care in uncertainty for about the future, they are practising sustainability.
A neighbourhood agreeing on water sharing rules during a drought or, uh.
A hospital unit informally coordinating changes to ordering, storage and disposal practices to reduce waste.
A community health committee working overtime to build trust, uh, between the clinic and marginalised residents.
These are all examples of sustainability in action.
A number of these efforts begin with a formal sustainability plan, nor with a formal sustainability definition or label.
They emerge out of necessity, shaped by shared values, by relationships, and by local knowledge.
And these practices, they don't look like the polished solutions in policy documents.
They are provisional. They are evolving. They are improvised.
They thrive on relationships and context specific knowhow.
They also frequently resist being quantified or scaled up, and they are often full of disagreement.
So yes, sustainability implementation is always already happening.
But it doesn't look like a project for a lot. It looks like people interpreting evidence and broad ideas in ways that make sense
locally or selectively reworking outside outside policies to fix they realities.
It looks like local actors continuously they're raping and violating.
Uh. What health? What care? What risk?
What future? Actually, in their context.
But the problem is that our current system often vendors these grassroots efforts invisible simply
because they don't fit the official template of what sustainability is supposed to look like.
I want to use the example of, um, Covid 19 to illustrate, uh, that point.
Uh, you all know that by 2019, the the world have had elaborate pandemic preparedness indicators and, uh, notably the,
the, the US that the UK ranked at the top of the Global Health Security Index for pandemic preparedness.
So the world's most appropriate countries on paper.
So then Covid 19 effects on those highly rated countries, they struggled and sometimes suffered quite bad outcomes in protecting their populations,
while some of their countries ranked, um below one that on that scale.
Uh, like countries in the global South, they mounted and trial and affected, uh, responses.
And how could that be? Well. The thing is, that's a full indicator so quickly because they missed a lot.
They measured things like stockpile supplies and emergency plans and surveillance systems,
but they didn't account for less tangible factors such as cross social cohesion, informal care networks, community solidarity, these softer elements.
They proved decisive. Uh uh, in the in the midst of crisis, neighbourhoods delivered food and medicine where formal system fell short.
Local indigenous leaders, uh, with community credibility, convinced people to actually follow public health advice.
Families. We care, uh, for sick relatives at home preventing hospital overloads.
None of this showed up in the preparedness metrics.
So in the eyes of those metrics, these crucial, uh, expenses, they simply didn't exist.
I want to introduce an alternative framing.
Um. 72 case studies that illustrate sustainability.
Understood. Very poetic. Uh, so lived that everyday practice.
Now, these examples, uh, they are both taken from a systematic review.
So that I recently co-authored on grassroots indicators in pandemic preparedness.
Uh, it is part of aim of the Lancet Commission on Rethinking Pandemic Readiness that was just submitted, uh, earlier this month.
And though these these examples come from very different contexts.
They both show what it looks like when sustainability is written from the ground up, rather than imposed from the bottom.
In community for vascular Health Promotion in the United States.
Evaluation has traditionally relied on expert design to indicate that a strong followed by medical and behavioural uh models, and uh.
These often focus on individual individual risk factors such as smoking, diet, physical activity, blood pressure, uh, cholesterol.
But measuring individual change at the population level is expensive.
It takes a long time and it requires also quite large samples.
The. A result, many community based prevention programs come across as ineffective or disappointing.
That's what this this whole it's not about not necessarily because nothing is happening,
but because meaningful change isn't showing up quickly enough in the individual health metrics.
So, as Chibnall and colleagues argued,
dominant evaluation frameworks are often not designed to to capture the kinds of
environmental and policy level change that many public health programs seek to achieve.
Informal, community driven initiatives such as neighbourhood walking bridge, community led improvements to parks and playgrounds,
local food sharing networks, uh and community gardens, uh pop up farmers markets, and volunteer organised health information campaigns.
They are might be significant for for health,
but these efforts often remain invisible within evaluation systems that define health
improvement primarily in terms of measurable change and individual level of care.
So, to better capture the effects of such community driven programs, Cheadle and colleagues, they suggested a different evaluation strategy.
Uh, they developed so called community level indicators that could capture these broader dimensions of prevention.
And they looked like things like that. Like, are our tobacco control laws in place are enforced?
Do neighbourhoods have accessible physical activity facilities?
Are there healthy food options and nutritional information readily available?
How many local organisations and programs are engaged in prevention efforts?
And these measures shifted attention away from just the end health outcomes like heart disease rates that you guessed to to should change.
So what signs that prevention was taking root in in the communities, environment and policy.
And importantly it shifted attention away from individual.
Uh. Responsibility to the collective.
A responsibility. And from a commercial standpoint, these indicators, they were messy.
They vary from place to place, so very hard to quantify and validate.
And they could easily aggregate the aggregate data into a single number or compared across communities.
And the researchers themselves are extremely traditional.
This is a quite old study. And they are they are. I mean they.
They, they they say themselves that that, that this that has many weaknesses.
Uh, that the indicators were preliminary that that they are imperfect.
Answer. But from a translational humanities point of view, that messiness is precisely the point.
Because these indicators, they make invisible forms of prevention that are informal, that are ongoing, that are embedded in everyday life,
efforts that are easily overlooked but extremely essential, uh, to how health is produced and sustained.
The second example. Uh, indigenous community health research in Canada, Australia and New Zealand.
Uh, for a long time. Uh, I'm still. Health and social conditions of indigenous communities.
Uh, have been monitored using indicators developed by non-Indigenous institutions.
And because they are designed for purposes like government surveillance and policy monitoring,
and they reflect dominant biomedical, epidemiological, uh, uh,
administrative, uh, assumptions about what counts as health, things like mortality rating,
service utilisation, standardised social determinants and so on.
And not surprisingly, uh, from the perspective of outside evaluation frameworks and indicators.
Indigenous health initiatives over the period us as lacking and ineffective indigenous led programs and forms of care, uh,
often considered as not evidence based because they don't move those those standardised needles,
but on the ground health and well-being in indigenous contexts.
Um, very much being sustained through which culturally embedded practices and these include community governance,
kinship networks, connection to land, language revitalisation, traditional healing, and also collective responsibility for care.
And these are forms of health practices that are widely recognised within indigenous communities,
but they are very poorly captured by conventional indicators.
And in response to this problem, an international group of indigenous and allied researchers led by Daniel and colleagues,
they developed a rating tool that allowed indigenous community members and researchers to evaluate existing health and social indicators.
Once again, they were not very bold in their visuals.
They they it's it's it remains very standardised in a sense.
And they want to develop something, a tool that can be scaled up.
I'm used to that and it's a similar community.
But there is something interesting in that. Uh, because each indicator was assessed using questions such as.
Is this indicator important to our community's notional health?
Is it culturally valid? Does it make sense?
Um, respect our values. Is it ethically acceptable?
Does measuring this cause harm or disrespect?
Is it feasible to measure this locally?
And then also, is it scientifically sound? And this participatory process, carried out across three countries,
made visible the ways many widely used indicators simply fail to resonate with community priorities and realities.
So some indicators that looked technically robust on paper,
but they were judged by the communities as culturally inappropriate, banned and even offensive.
And also at times, are the indicators that the mainstream might use as less rigorous game local authority because they were tied to,
to, uh, to history and, and relational and contextual notions of health.
But what emerged from this process was not the final checklist,
but the structured way of negotiating which indicators could meaningfully represent help and particular context.
So this this tool functioned as a translational device.
Almost like an interpreter between two languages or two worlds.
Tell translate them all so scientific validity and and comparability on one side,
and also the requirements of cultural meaning and ethical acceptability on the open.
And this translation did not collapse one into the other.
It did not force communities to accept indicators that spelled wrong to them, nor did it force the scientific side of the document vacant.
But it created a space of negotiation between and the kind of a third space, uh, for translation.
And the point is that both these case studies underscore the single overarching lesson that.
When we perceive failure through a narrow implementation lens, we tend to blame the doers.
We blame. We blame communities implementers for not achieving prescribed outcomes.
But often the real issue is that the framework for success is too narrow or too rigid.
What looks like a failure, uh, on the ground, can actually be a failure of the framework to account for its success.
So let me conclude by, uh, returning to, uh, the kind of provocative statement that I started off with,
uh, that sustainability and health care come up in a bit.
I hope that, uh, by now it is clear that this is not an expression of pessimism.
Uh, quite the opposite, actually.
Uh, it's it's an invite to more honest, um, uh, um, and ultimately also more, more hopeful way of engaging with sustainability.
Uh, if sustainability cannot be implemented as a fixed program, that's simply because it it's not a fixed program.
It is a living, contested, evolving practice.
So what do we do with this? Uh, insight.
What do we how do we move forward differently? Uh, I will quickly offer three role shaping, uh, an approach.
Uh, so, um. Uh, so, uh, some suggestions.
First, we must stop treating the. Believe it.
Um, negotiate the nature of sustainability as a flaw and start looking at this, uh, as a future.
Disagreement, contextual variation, moral debate.
These are not signs of failure to execute the client.
They are the substance of sustainability.
That's what sustainability, if it is to mean anything, must grapple with these fundamental questions.
What do we really sustain? What do we need to sustain and what do we allow to change?
Let's go. And. And displayed, uh, these questions.
There will never be one final answer to two such questions.
They will always be contested. But rather than trying to eliminate disagreement or force consensus,
we should design processes that can hold the disagreeing spaces where disagreement,
or where different forms of knowledge and value can encounter each other without one marginalising the other.
Second. We need to broaden the way we talk about and measure success and progress and progress.
If something important doesn't fit our indicators, perhaps the indicators are what needs to be changed.
And this could mean developing more grassroots or participatory pluralistic metrics
that can capture dimensions such as social cohesion and cross-cultural continuity.
These qualities are hard to quantify and compare, but as we know, not everything that counts is easily counted.
We also sort of complement our quantitative targets with storytelling, with community defined indicators.
And when we use standardised metrics, we should always ask what might we be missing?
And finally we. Embracing ongoing translation means also committing to translation as a two way, as a body directional.
Uh, Sri, it's not enough to expect communities to translate our policies or, uh, uh, scientific findings into their local context.
We, in turn, should also be translating local innovations and insights back into our policy designs.
And this two way translation acknowledges that sustainability is, as I tried to, to to argue, already happening at the margins, uh, the grassroots.
So rather than banging our heads against the wall, the why won't these people implement what's obviously good for them?
This redirects us to a more kind of reflective question how can we participate then?
How can we strengthen? How can we empower the forms of sustainable care and practice that are already taking root?
However small, how may the fragmented. It invites us to a more humble approach.
Uh, one of partnership, one of translation.
One of empowerment. So our task should not be, uh, to deliver sustainability from on high, but to learn how to recognise it.
How to engage with it. And how to take responsibility for neutering the sustainability that is already there among us.
Thank you very much. It's so much over.
I mean, it's so weird because, um, before we start taking questions on Weight Watchers from 915,
if you want to stand anywhere, sit back to your, um, logic of implantation with your.
One of the wheels will look like I'm coming in a little bit so they can see you on camera.
Trish Hines. I've never heard of.
That since I've been. I've just come back from Australia. So you've got terminal jetlag at the moment.
Um, but, uh, Steve, what am I going to say?
Hey, you know, discussant. And they said, why don't you tell them about Rob?
So I'm going to tell you about, um, throughout my son, um, um, a few years ago, nine years ago.
He's a, he's a marine biologist who trained as a biologist and went off to an island in Fiji.
Um, got the world's best job as a marine biologist.
Um. On an eco tourism island looking after the manta rays.
So there's this chain of islands in Fiji, and the channel between his and the next islands have been manta rays coming in.
His job is to look after the manta rays, but also to look after the reef.
And he was very interested in conservation.
And he's he's been there now for the last nine years, and he's kind of hippy scientist insisting I didn't need any shoes or anything like that.
He also links with research, uh, universities in various parts of the world.
And so this little island is time to take a walk round it in half a day.
Um, having had a number of things going on, which was absolutely resonant with what I've been saying,
is that when he arrived, this unsustainability was already happening.
Um, but it was perceived by the UN high is not to be happening.
And they had planned, um, some growth.
So his job was to tidy up the reef, make sure the reef was pretty big,
cause the kind of business model around was that there was an eco tourism company that can bring people, look after the village, free the people.
The Fijian people were working for this company and so they were getting paid.
So they apparently allegedly were happy. And then the tourists were coming.
And then Ralph's job was to make sure that there was a pretty reef and lots of manta rays for them to look at,
and then the money would go to get it there and that. There was a lot of contestation.
There were a lot of arguments, some fights over values, um, and judgements at stake.
Which story to tell you is a lot of stories I've been told about the Pirates, for example.
Yeah. Uh, I'll tell you about that, but.
But when I write the, um, hi solution, uh, for the problem of this brief, which was, you know, it was challenging to keep it in good order for the.
The saints problem was overfishing, and the perceived solution was, um, this was it with policy.
The present solution was a marine protected area NPA.
Now, the Fijians have been looking after this reef for a long time, looking after the island, all the rest of it.
Um, and they didn't quite see the marine protected area as the solution because they were doing all sorts of things.
Um, on the other hand,
Rome didn't really want to be lining up against the idea of a marine protected area because that is actually the way you protect reefs.
Also, the story goes anyway, there is no fix here.
There is no fix. The story is over the last nine years, every few weeks, a new thing, um, comes up.
The solutions are negotiating the ways for economic sanctions.
Um, I'll give you one example. He realised after he'd been there a couple of years and then the kids could swim,
and that the people who were looking after the reef were foreigners who were coming in on that gap years and getting these jobs.
And he was asking the locals, so why don't you let your kids swim?
And they said, William, like drunk. But also the kids didn't have any friends or any goggles.
And no, the ones that were used by the, um, the eco tourism company was too big for them.
So real good a donation of 1,000 FJD, which I think it's like three and quid or something.
Um, and bought some child size goggles and things and started taking the kids from the local school out.
Now, that was years and years ago because what he realised or not, it wasn't it wasn't Rob's idea.
It was that the community and the negotiations and the arguments and the relationships, um, they had to grow their own marine biologists.
So I actually had a friend who just got a job as vice chancellor at one of the Fijian universities.
So I knew that, um, the.
Problem was that the Fijian marine biologists were qualifying with a degree, but then not getting the jobs.
The jobs were going to Germans and Swiss and UK people.
And then Rob realised he was part of the problem. Hi. But he went to see the vice chancellor and he said, oh well,
the reason why your graduates are not getting jobs is that those students are very good at writing essays, but they have no field experience.
So let's have let's get a process going where they come and spend a month on the island,
and then they get a certificate from us and they've now got field experience.
We can show them how to remove the parasites through the reef and all that kind of thing.
Um, so he then had this relationship with the school,
and this was what we'd love for our local kids to go off to university and come back and be a marine biologist.
On this trip. I was, um, and that took a long time because kids were leaving school very young.
They were leaving school at like 13 or 14, even when they were really bright.
And why are you doing that? You got to a good school here. Well, because it's so horrible in the school and the school's a bad place,
and the school isn't really part of the kind of ecosystem because there's no toilets and there's just a dump,
and we pay into the ocean and nobody likes that.
So that was then the company like a tourism companies,
the other side of the island where everybody had lovely clean sparkling water and realised that the school needed running water, it needed toilets.
So there was a big thing about let's, let's raise some money. And then the school had toilets.
That took years and then it stayed on a school.
And now this school is sending youngsters, they stay to 18 and they go off to university and they study all sorts of things, not just marine biology.
Um, but I just the thing I've liked about this.
I thought you said if I. If I tell you, not tell about the poems on the midsummer nights.
Thing. And it happened in the pandemic, actually, that, um, I bombed that whole reef.
The pirates came and they they threw dynamite in the bombed out the reef for those three years,
work went when but pirates, when trying to think that children they children were starving.
You know you had a big argument with the pirates and then you realise something isn't right.
Yeah. There was no option. There was no well defined intervention.
Everybody saw the problem differently. So, so the the job description was to keep the roof nice and look after the match rates.
But then when you go to see the kids, you asked how many families are starving and the arrangement isn't working well.
But so so this was it was very much framed differently.
The goals of sustainability are always sustaining that rate.
Always sustaining. Who's working in that jobs, and whether or not the people from this community can actually look after the community.
This is very much that change definitely does not occur in an orderly, orderly sequence.
Um, and then legitimate authorities, yes, these authorities would come.
Um, but authority rested with the chief and it rested somewhere else and some other authority.
Um, so there is no solution on the silence.
But on the other hand. It kind of works.
Exactly. That fun? That's the other thing. You didn't really talk about that.
Something happens piecemeal. They bring in bits of money from bits, from research bits, from the tourism bits for grants and little research projects.
If you get one massive great big grant, I think that's problematic.
Sometimes, you know, you think it's wonderful, but then you have to implement the thing that as well.
I think one of the things that is made these islands in this community so resilient is the money has to come from all over the place,
and that's really nice. I think I've talked enough. But.
Yeah, I could tell you a bit more about HIV and drugs and things like that.
So much trash. Yeah, I haven't cushite before. We open up to the floor and we've got a couple of questions online.
Ask Lisa very briefly. Just respond to Trish. Yeah, well she's saying how it relates to it because I actually when I was working on this,
this talk and uh, and also when I was talking, I was thinking about Rob all the time.
I think I was writing this to, to to Trish the other day that I can't, I can't, I won't,
I won't be mentioning like mostly because I don't know all the books this very.
Yeah. But yeah, yeah. But I guess this is exactly it is exactly what this is about.
Because that kind of the work that he's doing, supporting the ongoing work that with all this,
all this complexity that you were describing, that is for me, that is what sustainability is about.
And he's a hero. I think it's just that he's my contact with this community, that there are so many people who are doing things.
Um, but then if you went in with a very narrow lens, you'd say nothing's happening.
Exactly. Yeah. And I just feel like he's to wrap up very quickly.
And firstly to the people online for sticking with us.
And thank you for joining to everyone in the room, and particularly the MSC students, um, and all the people on the course.
We've had a really long day, very productive, but I know you must all be ready to come back to work in the first.
Thank you for discussing the bringing Robin and even amazing a lot of ground, big staff and detail.
Thank you so much.