Health in All Policies – From Dream to Reality Through Track Two Diplomacy

By guest contributors Aleem Bharwani, Julia Palmiano Federer, Pamela Roach, and Peter Jones

Wicked problems need wicked solutions.

Wicked problems are “resistant, complex, and recurring issues.” Wicked public health problems encompass health inequities compounded by social inequities, including anti-Indigenous racism. Anti-Indigenous racism in the health system results in horrific consequences like the death of 37-year old Atikamekw woman Joyce Echaquan, who died while being abused and ignored by healthcare workers in Canada, who for no clear reason – other than racism – presumed she was in withdrawal when she was in fact dying of pulmonary edema.

Such wicked problems are not only defined by issue complexity in otherwise linear bureaucracies, but also by complex relationships and histories, often grounded in generations of mistrust and failed structures that were never built to meet the needs and aspirations of diverse communities – and in many cases, were built to explicitly marginalise peoples.

Because our systems are not built to promote healthy trusting communities, but to treat individual diseases, it has been said that we have a ‘sick’-care system rather than a ‘health’-care system. While healthcare policy falls cleanly to ministries of health, these determinants of health are distributed across multiple siloed ministries and orders of government – with no clear owner capable of stewarding generational relationships, consistently building trust, and mobilising resources for action across sectors and ministries.

Health in All Policies (HiAP), a holistic approach to health policy, acknowledges health and social impacts of any policy. HiAP is particularly important for addressing health inequities, mental health, and complex chronic non-communicable diseases which have multifactorial and multigenerational causes and treatments. It follows that any interventions to prevent and treat complex public health challenges, like racism, require a pan-sectoral, collaborative, generational, and generative approach. However, while laudable, HiAP is a dream without a plan. It presumes in an increasingly polarized world, that disparate parties are aligned to a common purpose.

In light of such wicked problems in the public health space, collaborative work is challenging where disparate parties are not always aligned to a common purpose and do not trust each other. This raises the following questions: who creates, stewards, upholds, and renews common purpose?

Track Two diplomacy (Track Two) is a tangible way to steward HiAP objectives by acknowledging the complexity and interrelatedness of a myriad of social and health issues that otherwise get trapped (or tucked away) and hidden in linear bureaucratic silos. Track Two diplomacy is a form of informal and unofficial dialogue conducted among conflicting or siloed groups. Often run by scholar-practitioners, who enjoy high levels of social trust, Track Two dialogues are intended to slowly build trust among those with profound differences through evidence-based workshops that, through ongoing discourse, transition from positional ‘bargaining’ to collaborative ‘problem-solving’. Historically, Track Two has been used in armed conflict settings, maritime disputes, and has been successful around the world including the recent Iran Nuclear Deal. More recently, Track Two methods have been applied to non-armed conflict settings, such as climate change.

To achieve these outcomes, Track Two convenes influential but unofficial actors to dialogue in an informal and open setting, often with experienced facilitators, known in the field as a ‘third party.’ The third party invites well-informed, thoughtful, connected players who are sufficiently removed from the political risks and constraints of official roles, making them ideally positioned change catalysts to pursue common purpose. In response to a normative imperative towards inclusion, Track Two methods are  evolving to be more inclusive of diverse communities and encourage local engagement and ownership where the conflict is taking place. These approaches, though unpredictable and slow, ensure outcomes remain durable.

While Track Two is a promising mechanism to realise greater health and social equity, it remains a predominantly Western approach to resolving conflicts and is often still conducted among elites. Therefore, while there is a great promise in Track Two as a tangible way to realize the goals of HiAP, a deep interdisciplinary dive is required to develop the potential role of Track Two in Public Health. What role can Track Two play to prevent and mitigate divisive public health debates? What can the field of Track Two learn from Indigenous and diasporic ways to develop more inclusive and decolonized methods and produce more durable and ethical outcomes that respect diverse and valid knowledge systems? 

Public health scholars and Track Two scholar-practitioners are well-positioned to collaboratively answer this call to shift to more inclusive methods that challenge Western-centrism and centre in community approaches. As skilled and trusted facilitators experienced in working across silos towards common objectives of peaceful coexistence in a shared space, we can work together to understand what shared ethical space looks like and preserve self-determination in next generation Track Two diplomacy methods.

Track Two diplomacy as a mechanism to achieve Health in All Policies offers a wicked solution to a wicked problem – but only insomuch as Track Two’s next evolution co-constitutes with Indigenous and diasporic ways.

About the authors:

Dr. Aleem Bharwani is a specialist physician and trained in public policy from the Harvard Kennedy School. He is now a clinical associate professor of medicine, and director of Public Policy and Partnerships for the Indigenous, Local and Global Health Office in the Cumming School of Medicine and the lead for policy and partnerships with the O’Brien Institute for Public Health at the University of Calgary. He co-founded the UCalgary Pluralism Initiative  and has been recognized nationally and internationally for his academic leadership. He is also an active community citizen serving on a variety of community and corporate boards. He can be found on Twitter: @AleemBharwani

Dr. Julia Palmiano Federer is the Head of Research at the Ottawa Dialogue, University of Ottawa. She holds a PhD from the University of Basel and an MA from the Graduate Institute, Geneva (IHEID) and has published academic articles and policy papers on diverse topics in mediation including Track Two peacemaking and multitrack diplomacy norms, gender, and counter-terrorism. She has also worked as a peace practitioner with the Swiss Peace Foundation and started her career at the United Nations Office for the Coordination of Humanitarian Affairs, Human Rights Watch and the Centre for Humanitarian Dialogue.

Dr. Pamela Roach is an Assistant Professor in the Departments of Family Medicine and Community Health Sciences at the University of Calgary and is also the Director, Indigenous health education in the Office of Indigenous, Local and Global Health for the Cumming School of Medicine. She is a PhD health researcher and member of the Métis Nation of Alberta who has worked in a variety of academic and community health care settings, both in Canada and the UK, over the last 18 years. Her research focuses on Indigenous health; brain health and dementia in underserved populations; and developing anti-racism educational interventions.

Dr. Peter Jones is an Associate Professor in the Graduate School of Public and International Affairs at the University of Ottawa.  He is also Executive Director of the Ottawa Dialogue, a University-based organisation which runs Track 1.5 and Track Two projects around the world.  He is widely published on the area of Track Two diplomacy.