Professor Carolyn Evans: Universities play a critical role in supporting and addressing the UN Sustainable Development Goals. A key aspect of this role is fostering an understanding of and engagement with the goals. Maintaining our health and quality of life is important to each of us and important to all of us as a society. While this issue has been brought into stark relief globally with the COVID-19 pandemic, across the world, for centuries, people have battled everything from outbreaks of infectious diseases to chronic health problems. The third of United Nations Sustainable Development goals is focused specifically on the aim of ensuring healthy lives and promoting well-being in people of all ages.
I am pleased to explore Sustainable Development Goal 3: Good Health and Well-being with two members of the Griffith Community who are deeply committed to improving people’s lives. Today I’m joined by Professor Elizabeth Kendall, the program director of the Disability Rehabilitation and Resilience Program at the Menzies Health Institute, Queensland, and Dr. Dinesh Palipana, a Griffith Medicine Graduate, lecturer and researcher
Elizabeth, Dinesh, thanks very much joining us today. Do you want to start by just giving us a bit of a sense of what SDG3 is all about?
Professor Elizabeth Kendall: Yes Carolyn, thank you. Sustainable Development Goal 3 is so important because it’s about ensuring good health for everyone across their lifespan. So, it’s about increasing life expectancy for everyone, it’s about reducing some of those common causes of death that could have been prevented, like chronic disease, traffic accidents, and, unfortunately, suicide. These are a really big causes that could have been prevented, and we could keep our population safe.
Evans: And women and children dying in childbirth, of course, not as big an issue in Australia, but a huge issue in many parts of the world.
Kendall: It is a huge issue, and yes, in Australia, we’re very, very lucky because we do have good health generally, and there’s a sort of 30-year age gap between our countries and those that are less fortunate than us. But even within our country alone, we have people with disability who are five times more likely to die before they’re 65. And that’s really not acceptable, because they’re from preventable causes, like heart disease, respiratory disease, and suicide.
Evans: So, Dinesh, some huge challenges. How do we even start to think about tackling such big and complex global problems?
Dr Dinesh Palipana OAM: I guess, I’ve been really lucky to have a perspective, being born in a country that’s had to do a lot with few resources and had to deal with a lot of challenges with a few resources. And I’ve seen the global inequity in health care delivery between a country that’s developed, in a country that’s still working on some of these things. So, I always wonder why I’m so lucky to have ended up in a place like this, where I’ve had a spinal cord injury, where my life expectancy is not in a matter of months. But I’ve been able to get by on good health care and good social support as well. At the same time, I’ve been able to see what’s achievable through focus and appropriate resource allocation. So, I think there’s a lot that we can do with a little and I don’t think it’s always about throwing money at the problem, it’s more about having passion and a good strategy, and good people on the ground, most importantly. But if I could pick one tool that can seek to readdress some of these inequities, I think it’s education. Across all these issues that Elizabeth just talked about, if we equip our population with education, I think we can go a long way in preventing a lot of these diseases, preventing a lot of the complications. The reason why I’m here talking to you today is because of the education I’ve got.
Evans: Including at Griffith, which we’re very pleased that you’ve been part of. So, it’s this role for universities, schools, of course, as well, and parents in the broader community. So, what role might there be for universities, do you think Elizabeth?
Kendall: Universities are central. You know, we’re educating the next health workforce for a start. So, we’re giving them the right skills and tools to be able to deal with surges of capacity, and to be able to do so equitably, and treat everyone fairly. We’re also a place of innovation. We’re a place where we can cross some of those boundaries, and we can start to work together to find new solutions to some of these old challenges that we haven’t been addressing well. So, I think universities, education, as Dinesh said, education is so critical to getting people into leadership positions and changing the way we deliver our health settings, healthcare. And it’s just so important to work in partnership, universities in partnership with government, with community, and try to solve some of these big challenges.
Evans: And as you said, the research element too, how do we know what to educate people, with respect too. There’s a time when people argued strongly that cigarettes were good for you. How do you make sure you actually, when you’re going out and educating people, educating them appropriately? Well, part of that’s the research work that’s done in places like Griffith and other universities.
Kendall: Absolutely, and we have shown that some of the things that we put in place can actually address these goals. So, road accidents, for instance, seatbelts and the airbags and things, the design of car that we’ve changed, they have made a difference. And research has allowed us to see that, but sometimes it moves a little too slowly, because we have to do things carefully. So, we need to work in partnership.
Evans: Now, you both talked about inequality and the role that inequality might play between countries. Dinesh, you’ve given an example of growing up in Sri Lanka, but also within countries. And I know each of you has had a lot of thinking to do about people with disabilities. Dinesh, what could, or should we be doing differently in a country like Australia, with respect to people with disabilities and making sure that they have the best possible engagement with health and well-being? And then perhaps thinking a little bit globally, what would some of the priorities be?
Palipana: You know, I had a spinal cord injury 11 years ago. Before then, I had no insight into what life was like for a person with disability. I thought, okay, it must be difficult not being able to move their legs. But did I think about the implications of not being able to use their fingers? Did I think about the implications of not being able to use their lungs? Or the implications of not accessing the community, the challenges in accessing health care or education? So, all these things, I got a very quick, real-life education into, after an injury. Sadly, even in countries that have a huge amount of resources – Australia’s an economic powerhouse – and even with the resources that we have, we still have challenges. Like Elizabeth said earlier, there’s still a life expectancy gap, there’s an increased risk of mortality. But I think a big part of this is just having discussions and allowing the population to know, because I’m sure there are people like me out there who don’t really know what the ins and outs of disability is like. But I think just making people aware of that and making people aware that there are real people behind these disabilities, and it’s really a person, I think that goes a long way in creating understanding. And by doing that, I think by creating leadership, we can also do so much for parts of the world that are under-resourced, that really don’t have the tools to do what we’re doing. I think leadership by countries like ours is so important.
Evans: I know one of the things you’ve done – you’ve personally, of course, shown great leadership – is starting to try and make sure that there’s a voice from people which is being in decision-making tables. And we’ve talked before about COVID-19, and some of the implications for people with disabilities. Do you want to just talk a little bit about the way, that perhaps, has gone wrong in some countries and how having people with the right voice at the table has made a difference here?
Palipana: People with disabilities are – in fact, many different groups within our society, experience inequities, and people with disabilities experience inequities at the best of times. But in times of crisis, these things that amplified, always. Whether it be natural disasters, whether it be wars, whatever. And the pandemic has been a similar thing, and it has amplified a lot of the issues. But I think the most confronting thing is how we as a human race, value life. And in certain parts of the world, people with disabilities have been de-prioritised from accessing life-saving medical care, like ventilators or intensive care, in favour of others who might have a better chance of survival. And I think that’s a really difficult ethical question and challenge to deal with. I am really proud to say that because of the way Australia has dealt with this crisis, we haven’t got to the point where we needed to make those decisions yet. But the other surprising thing that I’ve noticed, and again, by virtue of my education, and the employment that I have, I’ve been able to participate in discussions about how we deal with the pandemic and how we do best for all members of our society is that there aren’t many people with disabilities at these tables. And to me, that was really surprising because how do we understand the intricacies of what someone experiences in their day-to-day life if they’re not at the table? So, I think we need to enable people to participate in these conversations more.
Evans: And obviously, this has been a passionate view for a long time, Elizabeth. What other messages would you have to government about how we could better fulfil the promise of SDG3?
Kendall: You know, I think if we look at the healthiest countries in the world, which are often thought to be the Scandinavian countries, they’re putting a lot of attention into good, strong primary health care in the community. But they’re also focusing on broader determinants of health. So, health is such a complex thing. It’s not just about whether you’re sick or healthy, it’s about your whole life, and how that impacts. So, all of these SDG’s work together to create health. And you can’t be healthy if you’re living in poverty, you can’t be healthy if you don’t have a good house to live in. So, I think there’s a bigger focus on primary prevention, primary health care, having people access their GP’s well, and their community pharmacists, and get good health knowledge. But I think if we did that, we could address a lot more of the health challenges we’re facing. There’s some evidence that suggests that with our health systems that we currently have, we’re only targeting about 10% of our health problems. But if we look at a social determinants’ framework, or a primary health care model, we can tackle 80% of those health problems. So really, I think we need to reorient ourselves.
Evans: And we keep coming back to these in these discussions. One of the great things about the SDG’s is that they recognise that everything’s interrelated. You can’t just pull out health and say, let’s get health right. If people can’t breathe the air, without it clogging up their lungs because of pollution, if people can’t get access to health care, because of discrimination on the basis of race, sex, religion, disability, then, you know, it’s just not possible to focus on one. So, one of the things we like to do in these conversations is also try to think about what places that do this well do, and you’ve talked a little bit about some of the Scandinavian countries. If you’ve got some examples of things that have worked, well Dinesh or things that we could aspire to when we think about this?
Palipana: Interestingly, again, I was not born an Australian, but I’m proud to call myself an Australian now. And I have seen how things operate in different parts of the world. I’d say Australia does pretty well, actually. We have schemes that support people with disabilities, we have social support, we have universal health care, and we make an effort. We have passionate people. The way I see it, is that in this country, we’re trying to make a good thing better. So, I know people in the world, billions and billions and billions, don’t have access to the things that we do. So, I have to say that we do pretty well. We’re just working on making it better.
Evans: One is never at the end goal with these things, it’s always about improving, but it’s lovely to have Australia held up as an example of one of these conversations. And Elizabeth, what makes you optimistic in this area, what positive change have you seen?
Kendall: I think things like the NDIS do make me optimistic, but also the technology that we’re advancing now. So, in Australia, we’re really grabbing some of these things. And we’re saying that everybody should have access to technology that can improve their lives. I think we’re a long way from that, particularly in some of our rural and remote areas. But I think we have real capacity to solve these problems, if we continue to think differently and pick up the opportunities.
Evans: And one of the things at Griffith that we’ve been emphasising is not looking at these issues just as a medical issue, we sometimes sort of talk about from cell to community that we try and do everything from, of course, the absolutely critical work that we might have in biomedical research, which can find cures or make life better that way, but it goes right through to a community, and Dinesh, I think you’ve spoken about this too, the importance of people around you. Remember hearing one of our alumni, who’s a Paralympian saying the tragedy wasn’t the injury of the spine, the tragedy was the way everybody around me started treating me and excluding me from things you know? One happened, but the other needn’t have happened. Do you think we’re getting better as a community in this way?
Palipana: I think we’re getting better. I think it’s about having conversations. It’s about being open. And, you know, I also think it’s about celebrating and acknowledging the people that are doing things and that are making progress. You know, we as a nation, I think, have been historically a little bit shy, and we as institutions are sometimes shy too but, you know, we have people doing amazing work. And we have people of great diversity doing amazing work. I think by celebrating and acknowledging them, and having these conversations and having spokespeople, I think that goes a long way in, so called normalising what people are.
Evans: Well, thank you both, Dinesh and Elizabeth, for having this conversation today, and thank you for the work that you do to try and make SDG3 closer to reality.
PARTICIPANTS
Professor Carolyn Evans graduated with degrees in Arts and Law from the University of Melbourne and a doctorate from Oxford where she studied as a Rhodes Scholar. Carolyn taught law at Oxford and Melbourne Universities. Prior to commencing at Griffith, Carolyn held the positions of Dean of Law, Deputy Vice-Chancellor (Graduate and International) and Deputy Provost at the University of Melbourne. Carolyn works in the areas of law and religion and human rights and has published and spoken on these issues around the world.
Professor Elizabeth Kendall completed her PhD in 1997 on the topic of adjustment following traumatic- injury, for which she won the Dean’s Commendation for Outstanding PhD Thesis in 1998 (UQ). She has continued to build a research agenda in rehabilitation and service systems for people who are managing the consequences of serious injuries, disabilities or chronic conditions. She was an invited visiting Professor at the University of Manchester National Primary Care Research and Development Centre.
Dr Dinesh Palipana OAM Dinesh was the first quadriplegic medical intern in Queensland and the second person to graduate medical school with quadriplegia in Australia. Dinesh is a doctor, lawyer, disability advocate, and researcher. Dinesh has completed an Advanced Clerkship in Radiology at the Harvard University.
Dinesh works in the emergency department at the Gold Coast University Hospital. He is a senior lecturer at the Griffith University and adjunct research fellow at the Menzies Health Institute of Queensland. He is a research fellow at the Jamieson Trauma Institute. He is an ambassador to the Human Rights Commission’s Includeability program. He was a 2021 International Day of People with Disability ambassador.
and 2021 Queensland Australian of the Year.
