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Mabel: Hello, and welcome to The Lancet Voice. I'm Mabel Chu, Senior Editor at The Lancet, and it's September 2023. This year, for its 200th anniversary, The Lancet is shining a number of spotlights on underappreciated areas of health. Today, we're going to be talking about one of these, research itself. This podcast will discuss excluded voices and the decolonizing of research.

Our two speaker panels will discuss research involving indigenous communities in Australia and research involving communities from the global South. First up, I chat with Fiona Cornforth and Ray Lovett from the National Center for Aboriginal and Torres Strait Islander Wellbeing Research. at the Australian National University.

Welcome to you both. My first question is, what are some of the ways research involving minoritized communities excludes these voices? Fiona? 

Fiona: Hi, Mabel. I'm Deanna Kornblos. I have the huge honor of being the center head here at the National Center of Aboriginal and Torres Strait Islander Wellbeing Research, proud Wuthithi woman from the far northeast Cape of Queensland.

With family roots also in the islands of the Torres Strait. I think there's an approach that's traditionally taken where the people and community are subjects to be researched upon. That makes sense. And I, we know the quality of research. It's made by voices contributing knowledges. and perspectives to the research.

Too often, I think, research is coming with a limited way to conduct that research, and it absolutely compromises. The outcomes, the findings and the quality and in fact, it could be a waste of time to everyone. And what I've known in my career is that it could actually cause harm as well to many of those communities.

And that means that any research undertaken going forward is compromised as well. Thanks Fiona. Ray. Yeah. Thanks for 

Ray: having us, Mabel. My name's Ray Lovett. I'm a PhD student. A Nyanpa man from Western New South Wales have the great fortune of heading up the social and cultural wellbeing research area within the center.

Yeah. When I think about this question, I think about the word research and the word exclusion. And I guess from talking about my own personal experience in a way is the exclusion of, in our case, indigenous voices from the academy. itself which is the house that research is essentially built on.

The one stemming from Fiona's response is how research is conducted. So our academies are not built to conduct research in that way. And then researchers are not trained to conduct research that way as well. So the academy failing researchers or the development of researchers because of the way we're taught to conduct research.

So that also leads to when you are a minority or an indigenous person coming into the academy and the way you must work. With community and for community and really respect those voices because the context behind data collection, if we're talking about specific components of research, sometimes that can conflict with how the academy wants you to operate as a researcher.

Even when you make it into the academy, you're often still ubbered within the academy around how you have to work, particularly if you're working with your own people, which is philosophists, that's what we do. And then there's some legacy issues as well that you're dealing with in institutions around those.

stereotypes and the racism that's been present forever. Academies are not neutral, enlightened places either around those things. In fact, they've probably, researchers have, are responsible actually for much of that racism and stereotypes. It's very layered. In terms of exclusion of voice, even if you're a, you are a researcher in these academies.

Mabel: You've both raised some really important issues and I wonder if we might just delve into a couple of the points that you've raised. The first is Fiona, you've made the very good point that research that does not involve, properly involve indigenous communities, research about communities, such communities without properly engaging or involving these communities.

Not only compromises the findings, it can actually cause harm. Would you like to talk a little about some of the harms that might be caused? Front of mind in this discussion is the devaluing Torres Strait Islander knowledge systems and knowledges. And I've recently been able to celebrate some survivors of co logging industry, for example, and it was clear to everyone.

Fiona: Observing and having a look at their stories and their experiences, that there are knowledges there, that They were our warriors, our old people, the backbone of industry, yeah, in Australia. To devalue that knowledge and those perspectives and those experiences is hurtful and offensive because it's actually contributed to the place we now call Australia and the wealth of the country as well.

So that's one example front of line. And because the way we come to knowing may not be valued or recognizable by academies and traditional research methods and approaches, doesn't mean it's less than. In fact, there is so much everyone can take if we are able to honor it more in a very respectful way.

Mabel: Thank you, Fiona. So the devaluing of indigenous knowledges. Not only has the potential to cause harm and hurt. But it's actually a lost opportunity to honour and indeed benefit from knowledges that have benefited Indigenous communities and the nation of Australia itself. And we've also seen, I think, Mabel, that a good idea for research, I think the best researchers accept when in fact what they set out to achieve isn't actually a good idea for community and of service to community or industry.

Fiona: or nation building. So we should, it should be dropped. That should be the norm. But instead, harm has been caused in communities because there's this traditional approach that says, I'm researching you for my benefit and not yours. And I will take the approaches that I take, whether it is causes harm or not.

Mabel: You've also just underlined the importance of recognizing the potential for harm, which may mean stopping a project as harm to the community emerges, but ideally is prevented in the first place with proper involvement of the community from the very start at conception all the way through conduct. Ray, you mentioned stereotypes and racism that you've encountered.

Even as someone like yourself who's within the academy, would you like to give us some examples? 

Ray: Yeah, I've probably got two examples. One is very much at the, I guess it's the structural level within how research is actually funded and governed. Even in Australia, if we think about the NHMRC and the ARC, the two grant, research grant bodies that fund lots of research across the country, it's getting better.

So I have to preface it this way. But if we're talking about the ability for people to have a voice, so the people involved in the research to have a voice in the research itself, it's better now that you can actually be. Request funds to engage with communities, for example, it's limited, it's still limited though, very much limited.

And if you want to set up community governance over research, you currently can't argue for a resourcing to do that. So that's at the structural level, but then the really interesting one that I come across a lot, even here in the university is we are a discrete research intensive center. We are all researchers here.

We all run out in programs of research. We are seen by those outside our center as a way of providing entree to Aboriginal and Torres Strait Islander people across the country through our own networks. And so when other non Indigenous researchers require access to subjects for research, they will come to us.

Now my response to them is, if we require your assistance or expertise for our research, we will come to you for your expertise. Just to highlight that we have a certain expertise and we're here to use that for our research. But we still see this very much to this day that. We're like a lots of staff here to provide service to other researchers.

And that's not what we're about at all. So that still goes on. So that's something I'd like to see that. That these academies support us to do the really good research that we do with communities rather than seeing us as a way to access subjects. 

Mabel: Thanks Ray. That says a lot about deep seated perceptions and power relationships that need to be overturned.

So my next question to you both is, how can we do better? How can we be more inclusive? How do we decolonize research? 

Ray: We've had the Indigenous Higher Education Review. Conducted quite some time ago here in Australia. So there's this perpetual problem in Australia that we investigate problems like this.

So how can we do better around making the, or deco making the academy better, right? So more responsive to community research needs, better at supporting and facilitating indigenous higher education and research. So the problem we always have is the implementation of those things. Which the, I think the higher ed review was in 2012.

So we're over 10 years ago and we're still in the academy debating things like where if you have an Aboriginal and Torres Strait Islander researcher, where do they sit within the structure? When it clearly says in the higher education review, if you're trained in epidemiology like I am, you sit within epidemiology.

What we need is good indigenous epidemiologists, and that occurs most of the best way when you sit within disciplines. And it also has the byproduct of, we might think slightly differently about epidemiology to influence epidemiology as a science. For example, around the very things Fiona was talking about, or how do we come to know

that sort of epistemological approach or ways of knowing. Doing things like that is really good, while at the same time we have to be careful because some of these spaces are not necessarily safe. How do we support that in a safe way? And that's usually by having centres like ours that really can influence.

The university and the academy that way, while also supporting community and their desires around research. We're still tackling the funding and resourcing issue around how we work with community and those sorts of things, but we are doing better. But I think that's where we can do much better is really support these groups that influence particular areas of knowledge.

And support people coming through. One of the things I see in the academy, there's, there is some resistance because I've seen if you're providing resources to indigenous peoples or minorities within the academy, there's often some resistance because people see that as being inequitable, for example, weird argument that gets thrown around.

So that currently happens as well. So really highlighting what inequity and equity means and what racism means in these institutions to say, this is why we're prioritizing or as NHMRC puts it, structural reforms in place. We need to be doing more of those things. 

Fiona: Safety and cultural safety in particular.

It should be a North Star for all involved, but I know we're doing a lot better but we're doing better when the resources are being handed over for our self determination, for community controlled organizations or community controlled centers like ours to decide how we walk alongside community and how we honor those voices.

So that's really important and in health safety is steering clear of that deficit. I love how the center's always Honoring the strengths of our people and how we thrive despite the challenges. Though there is much work to do to, for example, close, close the gaps in health outcomes, there's a role that everyone can assume.

In healing, in ensuring that settings, health, and otherwise are as safe as they can be and that they don't perpetuate any further harm and that people have an investment and a demonstrated investment in somebody being well. And particularly our role in communities being well, that, that has to be one of the main reasons we're there and it has to show in everything that we do and how we approach it.

Time is a resource too, and time building relationships, for example, builds trust. And trust comes about because you've demonstrated that you're there to do influence, or you're there for intergenerational healing. And I've seen it, and I'm grateful that I'm part of a centre here that shows up in that way.

Though, as I said, if more people could assume a role in healing, whether they're a changemaker, collaborator, a champion, or a community, Remember, there'll be more of us walking together 

Mabel: to get better health outcomes. Thank you both for sharing your thoughts on how we can do better. Now I'm just going to list some of what you've already mentioned, respecting knowledges, safe spaces that can support researchers and communities.

Adequate funding and resources, honoring strength, taking the time and building trust, walking together. Can I ask each of you, as Indigenous research leaders, what's helped you on the way? Can you share any examples? What helps 

Fiona: me 

Mabel: is 

Fiona: the time span. It can be overwhelming and you can feel like change is too incremental.

There'll be a story that comes my way, usually through an elder or somebody like the pearl divers, for example. But there's also this story I carry with me from a survivor of the stolen generations. She had a very successful career as a nurse for the flying doctors and in some scenarios she was required to be a doctor, but she was institutionalized and taken from her family.

But there was a matron in a school, a nursing school in New South Wales that came to her dormitory and asked who wanted to be a nurse and she put her hand up. That lady went away for three days and didn't come back for three days. When she did, she said, pack your things, let's go. I'm going to teach you how to be a nurse.

And years down the track, she said. Why did you take so long to come back? I thought you didn't want me in that school and she said, I went back to the school and made sure everyone was ready for you to come, including telling them what the standard was for treating you, working alongside you and holding you safely in that space.

So there were stories like that that, that support leading in that same way in creating those safe settings. The other thing is how our people's bodies. managed responses to the COVID 19 pandemic. It was, there was no saying, a bureaucracy, they couldn't be a hundred percent sure that we would be successful if we were given the resources, if we were handed over the resources to do that.

But we did do it well, and quite obviously people died and people were affected in horrible ways. But that's something, that's a huge example of what happens when we're given the resources that were ours in the first place, that were taken away, to apply our knowledges and keep our people safe and strong.

Ray: Similar, in some ways. So yeah, when we started talking, there's a little picture that sits above this computer. It's my grandmother. So for me, it's quite a personal journey, I guess that's led me here. And so my grandmother was stolen and raised in a domestic training school, not too far from here, actually.

Mabel: Ray, before you go on I think it might be worth just for a global audience talking explaining what the policy was. 

Ray: Yeah. So the policy in Australia for quite some time from the late 1800s through to the 1970s, there was a specific policy that fairer skinned Aboriginal children Were become wards of the state.

So depending on the jurisdiction. So here in New South Wales, they come under the protector I don't know what who was called the protector and they were essentially the legal guardian for all Aboriginal kids in New South Wales And so they decided pretty much what happened to those children And here in New South Wales young girls were taken to domestic training schools to be domestic servants and young males were taken to agricultural.

So similar sort of arrangements that they were trained to be working agriculture primarily. So my grandmother was one of those children. So for me, when I think about my career path, what she, even though she'd been through that system and had very terrible experiences, often those children were not treated very well and in fact were often abused.

She, I don't know, she always maintained a bit of a rage, shall we say, that sort of lives on in me, I think. In that, she always talked to us about you. Your family and where you come from, no one can take that away from you, no matter how hard they try. And you really have agency over that when you think about that history.

That long history we have in Australia. Yeah, I'm one of those, maybe a disrupter, so I won't be told. I'm always so from her, that just that drive to be really putting out the forefront Indigenous people's wishes, particularly in research, because that's where I am. And really advocating that given I also have the site, the technical knowledge of one of these sciences to advocate so that those sort of mistakes in history are never made again.

Mabel: Thank you both for sharing some very personal and really moving stories. Before we finish, I'd like to just ask you if you had one take home message for our listeners, what would that be? 

Fiona: For me and my boys. It's committing to doing no further harm and assuming that role in intergenerational healing.

It's not outside your ring net. It's not in the too hard basket. It's quite clear through the work already undertaken, the heavy lifting of our communities, that it can and should be done. More researchers and more academies should commit to that. 

Ray: Yeah, and next, following on from that, Is, doing no further harm, and the best way to do that is for people that currently don't have a voice, ensure that they do.

And more than just having the voice there to guide things, we're running the show, essentially. So that's true self determination. Is we say what we want to do, and then the, we are supported to do that. 

Mabel: Thank you, Fiona. Thank you, Ray, for sharing your wisdom on how research can be decolonized. And thank you for showing us how we can all assume a role in healing.

Thank you. Thank you for having us, Mabel. Now, we're turning our attention to researchers in other parts of the world. And I'm now talking to Nancy Kankwanja from Kilifi in Kenya. Sudha Ramani from Mumbai in India, and Eleanor Wiley from Cape Town in South Africa. Welcome everyone. And to start us off, would you each like to introduce yourself and your work?

Sudha, let's start with you. 

Sudha: Good day to everyone and thanks, Mabel. This is Sudha Ramani and I'm based in Mumbai in India, as Mabel said, and I do research in the area of primary health care. I have particular interest in research on health policies and systems. Two of my colleagues are here today, Eleanor and Nancy, and three of us are from different parts of the world.

We are from different geographies, but we met through this health policy analysis fellowship. And that got us thinking on the way research on health policies and systems should be done in the global south. And we look forward to sharing some of these thoughts today. Yes, 

Nancy: thanks. So that and good day to everyone.

I'm Nancy Kaguanja. I'm based at the Kilifi at the Kemmery Center in Kilifi, where I'm a research fellow in the health systems and research ethics departments. My research interests include health policy analysis and Health system resilience and governance of health systems. Yeah.

So I'm really looking forward to sharing our thoughts. 

Eleanor: Hi, everybody. My name is Eleanor Wiley. I'm a lecturer in the health policy and systems division at the University of Cape Town in South Africa. And I came to this work, through an interest in how history, particularly in the South African case colonialism and apartheid alongside powerful ideas like neoliberalism and individualism, how these things continue to shape our health systems, our healthcare, and ultimately the health of communities.

And I'm very happy to be here today. And I just wanted to, on behalf of Sudha and Nancy as well, to thank you for having us here and inviting us to share our work. 

Mabel: We're looking forward to hearing what you all have to say. Thank you so much. And as this is a podcast on excluded voices and the decolonizing of research.

So my question to you all and it's the same question that we took to the other panel is what are some of the ways that research involving the global South excludes these voices? Sutta. Yeah. 

Sudha: Thanks, Mabel. The question you ask is really important, and we believe that the stories that we're telling in the Global South and about the Global South in academia often need much more depth.

So just to start with a story from one district in my dropbox was set up. And in this dropbox, people could drop in complaints. Complaint letter about any health facility. If you think of it from an objective sense, this sounds like a very great and effective intervention and one that is likely to make health systems more accountable to communities.

But when a district manager was asked what he thought about this Dropbox intervention, he shared very different worries. He pointed out that different ways in which the Dropbox mechanisms could be rigged. He spoke of the political implications of having such a complaint system. And he also shared that, he was worried that his his staff might go on strike.

And the point here is that the district manager did not really have any objective proof that any of this would happen, but it was his experience his tacit knowledge of working in the health system for many years, which told him this was mostly the most likely the scenario that will unfold. And unless we adapt this intervention, it is not likely to succeed.

The issue is that our research often ignores this tacit experiential knowledge. And when we ignore this knowledge our research becomes less valuable in practice in the global south. And this knowledge the thing is, it's possessed only by people who are working day in and day out in our health systems and not by experts outside.

And we really believe that one big problem with our research today is that we don't pay enough attention to this tacit knowledge that people have. I think my colleague Nancy, she has more to elaborate on this issue of tacit knowledge and different contexts. Thank you. 

Nancy: Thank you, Sudha. Yeah, I agree from the Dropbox example, it's quite clear that context matters.

And What happens is many times the contextual realities that determine how appropriate an intervention or innovation would be are often ignored. And so what happens is many standardized interventions end up not working as anticipated because this contextual realities, these local concerns were not taken into account.

And so when we think about context, many times what happens is context is presented as a set of social demographic variables. And this is really reductive. And because it really does not tell us about, complex issues, the complexity of, national and subnational concerns. Yet, these are very important elements that are important for us to understand health systems that we observe and interventions that we introduce into this health system.

Eleanor: Thanks, Nancy. Yeah, I think a big part of the challenge is just that in order to capture this Kind of tacit knowledge, informal research, and in order to promote a deeper understanding of these contextual realities within the global health community, we need to somehow move beyond our unconscious biases about evidence hierarchies that often results in the prioritization of quantitative evidence and positivist epistemologies.

These unconsidered assumptions about what counts as evidence, prevent critical examination of the global, social, and political determinants of health and the power imbalances that perpetuate them. And we're by no means the first to note that no real world systemic change can be achieved without tackling the social and political determinants of health.

Furthermore, in the field of global health, We, ourselves, as researchers, often, are often unwittingly complicit in perpetuating these regressive ideas about whose perspectives matter and what types of knowledge count as evidence. 

Mabel: Thanks, everyone. It's clear from what you say that we ignore local knowledge and expertise at our peril.

Interventions just won't work, and it's actually about more than just documenting demographics or background. We actually need to move beyond our unconscious biases and rethink what counts as good evidence if we want to properly tackle the underlying determinants of health. This takes us to my next question, which is, how can we do better?

Nancy. 

Nancy: Yeah I think that one of the ways to do better is so for example, to pay more attention to context is first, as you have noted, to move beyond the summary box of social demographic variables as context, and also to just present context in different ways, other than just.

A mere background of just mere background because it's really is the crux of what is happening and to give more space, more words to explorations of how and even why contextual, context matters. Yeah. I think so that you might have something to add. 

Sudha: Thanks, Nancy, for giving us that.

Great way forward for incorporating context into our research. Just to go back to the Dropbox example from India. I feel that we need better mechanisms to capture this sort of tacit experiential knowledge that people possess about their own context. We can know what a district administrator really feels about a Dropbox intervention only if we talk to that person at length and we try to pay attention and genuine attention to the kind of concerns that he or she is raising.

And for doing this sometimes our The traditional research methods that we have like surveys or the structured interviews, they don't really work well. First, I think one solution to to this kind of problem in research that is done with in ignorance of tacit knowledge that lies in looking beyond our traditional research toolkits.

We need to look beyond the positivistist paradigm that Eleanor had mentioned. We need to look more for problem solving methods, more sense making activities, and getting people to think and reflect along with you. We, as a research community we need to get more more comfortable with less structured and more free flowing ways of doing research that are more inductive in nature.

And Eleanor, I think is going to discuss even more about this shortly. Secondly, I also think that there are these ideas and theories available which can help to capture tacit knowledge and context, and some of them lie beyond the health realm. They lie in the field of organizational learning, some in political science, some in anthropology, and these theories can really give us a hook.

To sink deeper and capture the sort of tacit knowledge and but one solution we have is that we need to engage with more of these theories, more of these ideas to do deeper research everywhere. And Nancy, could you add a little more on this from your perspective, please? Thanks. 

Nancy: Yeah. Thank you.

So that if you think about context for us to understand context, we need more in depth, more nuanced exploration. So for example, this means understanding like the history that has shaped the health systems that we observe. And so this could be done, for example, through historical case studies, but this is especially important in LMICs.

Where the health systems or the local and the national governance have been shaped by colonial legacies. Further, we need to understand more about the political, the societal, and even the personal implications of interventions and innovations that are introducing to health systems.

And we also To get deeper into context would need to engage more with the societal values and the cultural norms of the people who live in these health systems or work in the health system. And so I think that understanding context in this manner can help us to decolonize research.

Eleanor: There are so many research approaches available. To us to that would that allow for this kind of exploration, but sometimes we are hesitant to use them because we feel like they require, a more subjective perspective. And that makes us wary, but for example, methodologies like discourse analysis are very established in other fields and can really allow for an in depth exploration of how ideas shape how we understand global health challenges.

And even circumscribe the range of solutions that we consider feasible and are a really great tool for understanding sort of values and ideas and politics and power imbalances, as Nancy was mentioning, I also think that, history and historical case studies can really help us. To explore the influence of social and political factors on health systems at the global level, as well as at the national level, and are really particularly well suited to revealing how social power dynamics and politics undermine equity oriented reforms and why they undermine equity.

Oriented reforms and how we can overcome those challenges. And then I think just to add that we have to recognize that we as researchers are very much a part of this deeply unequal system of knowledge production and the right kinds of research can really help us to look at. Inwards to some of the hegemonic ideas that pervade global health as an academic discipline, as a field of practice, and that often mean that we unwittingly reproduce these regressive ideas.

These methodologies can help us turn our gaze inwards towards ourselves and understand how our ideas that are shaping our discipline perpetuate inequities in the production of new knowledge by unconsciously reinforcing old ideas. But it's really hard to place this kind of research in global health journals research that requires relativist or non positivist perspectives are really underrepresented in global health journals, particularly in those that are most highly ranked, most widely read, and therefore most impactful and the result is that This kind of research just doesn't get read widely enough to spur systemic change or worse still is simply never published at all and is excluded completely from the discipline.

So I think part of the solution is also just making space for this kind of work in the most widely read journals. And this means physical space in terms of the actual word count, because, this kind of research requires some in depth analysis that takes a bit of time. time and space to explain, but it also means just including, expanding the scope of global health journals, making sure that when such research is submitted, that it's reviewed by appropriate experts and making sure that it is featured alongside more traditional global health research so that it can be read more widely.

Mabel: Thanks very much for your constructive suggestions. Now, you've mentioned the challenges of under representation, and I'd like to take things to a slightly more personal level, if I may, bearing in mind there may be listeners to this podcast who are at the start of their research careers, or may even be in the pre contemplation state.

What's helped you along the way? Can you each share an example of something that's helped you to overcome obstacles? 

Eleanor: I think something that's helped me, definitely because one can often feel a little bit out on one's own in this discipline when you're doing it. One is trying to do this kind of work. It's a, it's can be a scary and lonely and isolating place to be.

And I found so much comfort in reading more widely beyond the field of global health into, the social sciences where people are really pursuing these kinds of issues and writing so interestingly and passionately about these kinds of issues. Challenges. It's just that we don't always see it within the field, but it has helped me so much and inspired me so much to read really widely and really deeply in the social sciences.

Nancy: Yeah, I'm just it's quite related to I mean what Elena has said, I guess for me what has helped me also coming from a background that is not exactly, you know that I'm not exactly use some of the research approaches that we are proposing. Just engaging with with groups or communities of parties where these kinds of research approaches for them interdisciplinary work are, is to say they have more experience has helped me.

And one, I know this was mentioned at the beginning, how we all met. But for me, being part of a fellowship where the use of these kinds of research approaches is encouraged and is seen to have value and to be contributing back to the how health Policy and health system is shaped.

Has been valuable. It has given me, confidence to move forward. In, in applying for example, more qualitative approaches to my work. So being part of a transdisciplinary team and also presence in for example, the health policy analysis partnership has been quite helpful.

Sudha: Thank you. I I would like to echo Nancy's point, actually. Being being in India, where I work with a very diverse set of researchers, all coming from different different backgrounds we are also a very hierarchical society in general. Just exposure to to a different way of doing things was very very helpful for me.

And I feel that to to get the minority voices stronger or to get our voices the way we can do it is get together a little more. So when we establish more networks across geographies there's a feeling that you're not alone in feeling These things and, your voice is being recognized and there are people to have your back and support you when, and they feel the same way.

And that is very liberating for me, even this opportunity for us to talk in a podcast like this, I think it's fantastic because we we feel more heard and Coming from three very diverse places the views we had were so similar to each other that we were very happy to take part in this together.

Mabel: So I can hear some common themes. You've all mentioned the importance of exposing yourselves to a diversity of perspective. And I can see that's certainly not a theoretical construct for you. It sounds like you've all benefited from connecting and expanding your perspectives through other people and through networks.

The other theme I'm hearing too is your encouragement for listeners to grab opportunities whenever and however they arise. If you have one take home message now for our listeners, what would that be? 

Sudha: Thank you, Mabel. I think first, we would like to thank you for listening to us today, and we have three messages and on behalf of Eleanor, Nancy, and me, I would like to deliver them.

The first message is that right now, there are incredible people who are doing great hands on work on health everywhere. And we need to do research that respects their knowledge, and we have to start treating their knowledge by valuable evidence. The second message we have is that there is of course a need for more work to be published from the Global South and from minority communities.

But there is also a need to listen to these people. These communities much better in the kind of stories we tell like Eleanor said, we need to challenge. We need to critique the dominant perspectives in the field. And like Nancy said, we need to pay close attention to context and the third final message from us is that.

The kind of complex problems we encountered in public health today, these are not very easy to deal with. They need a variety of perspectives and a variety of research tools. And we really need to move beyond the biomedical realm, and we need to use these tools which are available to us. At the moment we think that as a research community we, if you look inwards, we are not doing a good enough job of being inclusive and this is being recognized and we are realizing that we can and we must do better.

So thank you. Thank you for listening to us today. 

Mabel: Thank you for a really helpful discussion. You've helped us understand the need to change our mindsets to prioritize local understanding and expertise. And you've also challenged us to consider nuance and context. and to reconsider what constitutes good methods.

So that can only be a good thing. Thanks again, everyone.

Gavin: Thanks so much for joining us for this episode of The Lancet Voice. This podcast will be marking The Lancet's 200th anniversary throughout 2023. by focusing on the spotlights with lots of different guest hosts from across the Lancet group. Remember to subscribe if you haven't already, and we'll see you back here soon.

Thanks so much for listening.