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Trailblazers with Garry: a conversation with Adalsteinn (Steini) Brown
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"Trailblazers with Garry" is a new series from Global Health Matters, where host Dr Garry Aslanyan sits down with trailblazers — thinkers, leaders, and influencers shaping the future of global health — for short face-to-face conversations, available in both audio and video formats. It’s a chance to get to know the people behind the work and hear their perspectives on the current global health landscape.
In this Trailblazers episode, Garry sits down with Adalsteinn (Steini) Brown, Dean of the Dalla Lana School of Public Health at the University of Toronto, to talk about the future of public health education, learning health systems and the core competencies tomorrow’s leaders will need to make an impact on public health.
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Welcome to Trailblazers with Gary, a serious but Global Health Matters podcast. I'm your host, Gary Slan. In this series, I sit down with Trailblazers in Global Health for short face-to-face conversations which you can listen to in audio or watch the video. It's a chance to get to know the person behind the work, hear their stories, and gain their perspectives on current global health landscape. Join me as we explore the people, places, and ideas driving global health forward. Let's get started. For this episode, I found the opportunity to meet with my longtime colleague Analystyne Brown, or Steine as he's better known, for a conversation. Staney is the dean of the Dalalana School of Public Health at the University of Toronto. His previous experience includes senior leadership roles in policy and strategy with the government of Ontario, one of the provinces in Canada, in private sector roles and as well as global work on healthcare performance measurement. In our time together, Stane shared on what it means to lead and learn in today's public health landscape. From personal reflections on the values that shaped his path to insights on what it will take to build transformative health systems and training the next generation of public health leaders. This episode captures the essence of the kind of leadership needed for a healthier and more equitable future. Hi everyone, welcome to another Trailblazers with Gary episode. And I'm here in Toronto, Canada, at the Dalalana School of Public Health at the University of Toronto, and the School of Public Health here is very, very well known in North America and is number one in Canada. I have a fortunate situation here. I was able to find time with the dean of the school, Dr. Staney Brown, Adal Stein Brown, and we'll be chatting about public health and public health education. Great. So welcome to Global Health Matters, Staney.
SPEAKER_00Thank you.
SPEAKER_01Coming here, I just realized that I think you and I have known each other about 25 years. It's pretty much 25 years. Can you imagine? So that's interesting. I do, I did, yes. I don't know. I did nothing special about it. Maybe we can get started by maybe you telling me if there was a person or somebody who uh really had an effect on you how you look at public health, how you look at the health systems, uh, and um how that really shaped your career in public health.
SPEAKER_00Sure. So to be honest, the the person who probably helped me think most about public health and about health systems was my father. Uh-huh. Uh I've uh he was a physician, uh full-bore practicing academic physician, would see thousands of patients a year. He'd spend Sunday mornings just driving around uh talking to patients who couldn't get into the hospital or who couldn't get to see them. It was just a way of making sure they stayed connected and that he worked through. And you know, it wasn't anything you could bill for, it wasn't part of the practice model, it was just the house call and part of being a good doctor at that time. And what struck me, I think, most profoundly, and it affects how I really always try to approach public health and health systems, is that the people who are in these systems, they generally really want to be here. There are people who could do any number of different jobs. Uh, you generally want to approach them talking about how it's better for their patients, or it's better for the populations they serve, or it's better for the communities that they uh they want to help. And at that point, it's always a very easy discussion. Because they're interested in the same thing. If you approach them and you want to talk about a fee code list and how much you should be paid for this surgery, or you approach and you want to talk about budget first. That's never the right way to approach it. But if you approach it from how do you get people healthy and keep them healthy, how do you help people have agency and opportunities in their life, how do you help people fulfill that kind of really kind of the intrinsic rewards they want out of their job? Then it's a really often both, I think, productive way of approaching folks, but it kind of keeps hope and vision and excitement and passion going.
SPEAKER_01Great. So that's interesting. So you had a number of leadership roles, both in the government and now, of course, here as the dean of School of Public Health. What kind of leadership values uh you kept and you made sure that are instilled in your day job? Sure. What what what were they or what are they? Sure.
SPEAKER_00So I think the values you have as a leader are the same values you should have as a person. And, you know, at the end of the day, that really shouldn't vary that much across people. Um but I will say that, you know, at least the way that I approach leadership, it changes on you know the context and type of problem I've got, the type of people I'm working with, uh, where they're coming from. That changes all the time. And I'll I'll tell you a story that um I often talk share with people I'm working with, uh, sort of give a sense of how I think it has to change. So a number of years ago, I was up for what would have been a career-changing role. Uh it was the vice president of a very large organization, and it came down to the final set of interviews. There were some board members in the interview, there was the CEO in the interview. And one of the questions that uh I got asked was, What's your leadership style? And I gave what I thought was a great answer. I thought it was thoughtful, eloquent, you know, the sort of tough but fair sort of stuff. I just thought I knocked the question out of the park. And when my mom was still alive, we'd we'd talk about these things after.
SPEAKER_01Okay.
SPEAKER_00And so she said, Tell me about the interview, and I went through it. She said, What'd you say? And well, this. And we came to this question about what my leadership style is. And she said, Okay, well, what'd you say?
SPEAKER_01Uh-huh.
SPEAKER_00And so it was soon enough after I thought I pretty much paraphrased it. I was really proud of my response again. She said, That's the stupidest answer. Uh-huh. There's only one word for that, and it depends. You know, if you're going into a hostile situation or you're going to a place with people you haven't met before and you haven't established that relationship, you've got to have one style, right? You've got to be direct, you've got to be thoughtful, you've got to be engaged. Uh, if you're going to another situation that's in the middle of a crisis, you've got to be really good about communicating clearly and making sure that people understand the why right off the bat. Uh if you're going to another situation with people you've worked with for a long time, you can kind of sit back and you know what the dynamic's gonna be. But it the the style changes all the time.
SPEAKER_01Okay.
SPEAKER_00Values, they shouldn't change. You know, you should never be kind of compromising on you know what you think is fair, what you think is equitable. You should never be compromising on what's you know honest or what's you know straightforward. Uh those should be constant regardless of the role and regardless of who you are, right?
SPEAKER_01Right, right. But adapting to the situation is you will have to do that all the time. Yeah, that's uh that's a good message.
SPEAKER_00And I guess you know that's that's the other thing, right? If you're adapting, that means that you're probably listening to start. That is maybe one consistent thing for me.
SPEAKER_01Okay.
SPEAKER_00Anytime I'm in a situation, I'm trying to listen before I talk. And the longer I listen and the more advice I get, the better I do.
SPEAKER_01Okay. So recently you've published a paper with some of your colleagues about leadership in learning health systems and how the leaders need to be guided by certain values of equity, etc. What is this concept and what where did that come from, if you can um uh shed some more light on that?
SPEAKER_00Sure. So, you know, the the concept really comes from uh Nahir Lyfoon, who was a postdoctoral fellow of mine at the time. And she started doing some work talking, really looking at equity and performance measurement, because everyone says they're measuring equity, and when you kind of dig into it, it's not really looking at equity in the way that we'd sort of fully understand it. And there's lots of people who have written about what this would look like. Uh Arlene Beerman's written some really thoughtful stuff. Other folks have written really thoughtful stuff about what it would mean to measure equity. Um, but when Nikia, when she started to dig into this, you started her thinking, because she works in a group that uh you know spends a lot of time focusing on learning health systems, she got thinking about why aren't learning health systems really kind of using data and studying and moving uh equity forward as fast or as well as they could. And so what we you know, when we talk about equity as sort of a leadership competency or trait, we're really talking about an understanding of equity uh in its fullness and how that relates to the types of decisions and tools that a manager has in front of them, right? Measurement, accountability, communication, strategy setting, and how it has to infuse into those and not be an afterthought.
SPEAKER_01Okay.
SPEAKER_00And so it's, you know, I I think it's a great paper. I'd love to take more credit for it than I can. Okay. Nakia did a wonderful job with it, but it's really about understanding its fullness and then implementing in its fullness and not giving lip service or treating it as an afterthought.
SPEAKER_01Right. Because a lot of the health systems around the world, and we cover a lot in the podcast, people working, they all want to have resilient learning health systems, and there's a big push for that because the resources are not going up.
SPEAKER_00Yeah.
SPEAKER_01So they are really dealing with what they have. So these are very interesting reflections because they need to be led or organized by people and by systems that actually are uh learning and and and leading them. Thanks, uh, thanks for that. Um in your view, what one or two things need to change?
SPEAKER_00Sure.
SPEAKER_01In well, in Canada we have public health and then we have health systems. Um a lot of our uh listeners are working in systems where these two things are together. Yeah. Right? So, but in your view, what are two, three things that need to change to really for us to get over uh the what we sometimes feel a bit of a um uh slow um in in learning system introduction or it's not as quick or obvious.
SPEAKER_00Yeah. So you know, John Overweight uh said this very interesting thing in a report he did for the Health Foundation. And I'll I'll paraphrase and maybe I'll get a little bit wrong, but but the essence of it was improvement saves money. So doing better is cheaper. But he says, you know, where you make the effort to improve is not necessarily where you reap the savings.
SPEAKER_01Uh-huh.
SPEAKER_00And when you make the effort to improve is not necessarily when you get the savings, right? And so you know the way that you create value in public health and health care can, you know, it can happen in a school, it can happen in a clinic, it can happen in a hospital. But the benefits don't happen usually right away, right? They can happen a year later, they can happen two years later, they can happen ten years later. And they don't necessarily happen in the same place, right? If you have much better health literacy and people can take care of themselves, well, they'll be healthier later in life, right? And there'll be avoided cost later in life. And it won't be in the school where it was taught or the primary care clinic where it was sort of shared. It's somewhere else, right? It's often in the hospital that doesn't see the admission, or it's the long-term care home, or the nursing home that doesn't see the resident, right? They live in the community rather than being institutionalized. So, you know, that's I think one of the most important things that we miss all the time when we like to get into the minutiae of health policy, right? We'll put a little bit of money here, a little bit of money there. I think we need to lump money together, and we need to leave it to systems to manage that money well, these sort of bigger and bigger budgets, uh-huh, so that they can actually kind of start to invest where the payoff's gonna be the biggest. Okay. And and this is like a profound change, right? If you think about this, we separate everything according to sector here in Ontario, that gets in the way of that type of joined up action that will actually create a sustainable system. And we reconcile the books every year and take away any money that's extra. That gets in the way of actually that sort of long-term investment.
SPEAKER_01Okay.
SPEAKER_00And if you look at the good systems in the world, you know, there's little bits and pieces that change, but it's almost always this idea of, you know, I'm talking about systems, not episodes or types of care. But systems, they're investing, and they're investing with an eye to the future, and they're investing from a whole system perspective. So that'd be the biggest thing I think should change. Okay. Um I think there's also a need to start to uh really change some of the competencies uh which we instill into our uh our researchers and our leaders. Okay. So we talked about equity and understanding equity, that's true. But you know, we're now in Canada trying to move towards these new competencies for some of our PhDs where they're actually able to work more closely in the system, work more closely with the system, understand what they need to do to see impact. Um and I think that's you know, on the flip side, the numeracy and the facility with evidence that's gonna be required of managers and systems to continue to evolve is gonna be profound. And so you need to see that kind of deepening of skill sets on both sides, and I think that'll be that'll be a really long-term, I think, successful strategy. And if we're gonna harness AI in a way that produces value, that sort of kind of understanding on both sides, how is this gonna get used? How can it be used better? Who will use it? Okay. And then with the system, how do I query these numbers? How do I ask the right questions of these numbers? How do I understand what they're telling me? Uh, those are gonna be critical skills that we need to kind of deepen.
SPEAKER_01So if I build on that answer, it's basically we are recognizing that we have way too many new things that we have to deal with: AI, globally geopolitics, disinformation, misinformation, a lot of other things that are coming, climate change. Um so the public health education or public health training needs to really change. Uh I was I had a guest on dialogue, um, Chikwe, who now is going to be the Assistant Director General for Emergencies at WHO, and he said all the easy problems have been resolved by our previous generation. Now we have to resolve all of these new things. Although I'm sure every generation thinks that they are are facing the challenge of the generation. So, how uh would you change public health education? And this is something too also, it's very relevant globally. Uh, what would be things that you would change how we train public health leaders of tomorrow?
SPEAKER_00So I I think everyone is gonna have to be highly numered. Uh, whether you're a qualitative researcher or you are someone who takes you know a very critical perspective and builds off that rich theoretical background, everyone's gonna need to be numered. Uh there's no way around it. Uh and that's just gonna be a core company regardless of what you focus on. I think we're gonna have to teach as well the skills of how you work in teams, you build networks, you manage projects and you deliver, because public health is an applied science, right?
SPEAKER_01Of course.
SPEAKER_00And it only sort of matters when it can kind of get to that level of application. And so I think that sort of, you know, understanding those skills uh is gonna be critical. And again, I think it's gonna be critical whether you are, you know, we've got some superb critical qualitative researchers here. Um, but you know, you'll watch uh some of them, they can write now in a way that they write a bestseller about a critical health issue. They can take these sort of incredibly sort of cutting edge, you know, bleeding edge sort of concepts that you'd say, oh well that's uh purely theoretical. And they can talk about why it's gonna change or help build a healthier system. Like the the best of them have these sorts of skills. And so I think that's gonna be critical. I do think communication is a skill that we uh you know we uh as a uh as a discipline we have great challenges with, uh, and not just during the pandemic for a number of years now. And the ability to communicate honestly, directly, clearly, and simply is critical. And it's not just to um you know a public or a lay audience. Right. Uh the decision makers and governments and uh and corporations around the world, they're faced with an onslaught of decisions.
SPEAKER_01Any information.
SPEAKER_00Yeah, and information. And they need help kind of making sense of it. Uh so I do believe that you know communication is going to be a critical skill. Uh and then I think you know, finally, it's um it is always critical that we're kind of reflective, that we understand history, uh, that we understand kind of what we can learn, how we can kind of manage the world going forward. And you know, organizations have to deal with this. They think about foresight, they think about history, they think about simulations. These are all types of things that we kind of need to see more of in public health education.
SPEAKER_01Okay, great. Thanks for those. Um, I'm sure this is uh a lot of the um our listeners are really interested in this, um, and so thanks for those reflections. Are you um uh really um thinking that the leaders of tomorrow are ready to take on these challenges we have? Sure.
SPEAKER_00So, you know, part of getting older um is talking about how things were different when you were younger. Right. So you know there's always that sort of bias there. Look, I I think uh when I talk to some of our students, whether they be undergraduates or graduate students, um, what you see uh is a remarkable uh wealth and depth of kind of passion for helping people get healthy. I've I've only seen that intensify over time. I haven't seen that diminish. Um I'll see some of my students just navigating new tools and techniques that you know I'm probably too old to even learn. Right. And they navigate them really easily. Um I'm working with a student this summer, and I kind of throw a sort of a half general question to him. And within two weeks, he's been able to use a whole bunch of sort of new ways of navigating databases, navigating the internet, uh, to bring back some really interesting findings.
SPEAKER_01Okay.
SPEAKER_00And, you know, it's it's a depth and it's a maturity and it's a thoughtfulness that I'm really impressed to see in someone so young. So, yeah, I are they ready? No. By definition, they're just emerging leaders.
SPEAKER_01But you're optimistic.
SPEAKER_00I think they'll get there.
SPEAKER_01Okay. Well, great. Thanks for this, Daney, um, for a very insightful quick interview and finding time for us. Right. Uh so um, our listeners, uh, again, I was speaking with Adelstein Brown, the Dean of the Dalalana School of Public Health at the University of Toronto here in Toronto, Canada.
SPEAKER_00Thanks, Gary.
SPEAKER_01Thank you for joining me for this episode of Trailblazers with Gary, brought to you by the Global Health Matters Podcast. The audio and video versions of this episode are available wherever you get your podcasts. Be sure to visit the Global Health Matters webpage for more information about my guest and this series.
