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Changing roles of universities in the era of SDGs: rising up to the global challenge through institutionalising partnerships with governments and communities

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Abstract

The 2030 Agenda for Sustainable Development covers a wide range of interrelated goals, including poverty eradication and economic growth, social inclusion, environmental sustainability and peace for all people by 2030. Policy decisions to meet the Sustainable Development Goals (SDGs) need to be informed by policy-relevant evidence co-designed and co-produced with the pertinent stakeholders, taking into consideration local and political contexts. Universities are uniquely placed to lead the cross-sectoral implementation of the SDGs and advance the 2030 agenda. This commentary provides the case for building, strengthening and institutionalising university partnerships with governments and communities to achieve the SDGs. The authors call for a change in mindsets and culture in both academia and government, and invite both parties to start the dialogue if we are to rise up to the global challenge.
C O M M E N T A R Y Open Access
Changing roles of universities in the era of
SDGs: rising up to the global challenge
through institutionalising partnerships with
governments and communities
Fadi El-Jardali
1,2,3*
, Nour Ataya
2
and Racha Fadlallah
1,2,3
Abstract
The 2030 Agenda for Sustainable Development covers a wide range of interrelated goals, including poverty eradication
and economic growth, social inclusion, environmental sustainability and peace for all people by 2030. Policy decisions
to meet the Sustainable Development Goals (SDGs) need to be informed by policy-relevant evidence co-designed and
co-produced with the pertinent stakeholders, taking into consideration local and political contexts. Universities are
uniquely placed to lead the cross-sectoral implementation of the SDGs and advance the 2030 agenda. This
commentary provides the case for building, strengthening and institutionalising university partnerships with
governments and communities to achieve the SDGs. The authors call for a change in mindsets and culture in both
academia and government, and invite both parties to start the dialogue if we are to rise up to the global challenge.
Keywords: Sustainable development goals, universities, institutionalisation, government, community, partnerships,
governmentacademia, cross-sectoral collaboration
Background
The 2030 Agenda for Sustainable Development puts for-
ward a broad and ambitious agenda covering a wide range
of interrelated goals, including poverty eradication and
economic growth, social inclusion, environmental sustain-
ability and peace for all people by 2030. An analysis of the
Sustainable Development Goals (SDGs) demonstrates the
interconnectedness of the goals and targets, with various
nexuses identified among sectors, such as the education,
gender and health nexus; the energy, food security and
poverty eradication nexus; the water, energy and food
nexus; and the climate, land, energy and water nexus [1].
The depth and breadth of the SDGs necessitate concerted
and coordinated efforts across all sectors and actors [2,3].
Achieving progress on the SDGs will undoubtedly
require the involvement of governments to work across
policy areas; however, political commitment alone will
not suffice without mechanisms to steer their implemen-
tation. Policy decisions to meet the SDGs will need to be
informed by policy-relevant evidence, co-designed and
co-produced with the pertinent stakeholders, taking into
consideration local and political context [4].
Universities are uniquely placed to lead the cross-sectoral
implementation of the SDGs, providing an invaluable
source of expertise in research and education on all sectors
of the SDGs, in addition to being widely considered as neu-
tral and influential players. While the focus of this com-
mentary is on the role of universities, it is acknowledged
that think tanks and other institutions involved in the pro-
duction and communication of knowledge also have an im-
portant role in advancing the SDG agenda.
Worldwide, some universities have started to come on
board with the SDGs, prompted by United Nations-
supported initiatives such as the Higher Education
Sustainability Initiative, the Principles of Responsible
Management Education initiative, and the Sustainable
Development Solutions Network [5]. However, the ques-
tion remains as to how universities, particularly those in
* Correspondence: fe08@aub.edu.lb
1
Department of Health Management and Policy, Faculty of Health Sciences,
American University of Beirut, Beirut, Lebanon
2
Knowledge to Policy (K2P) Center, American University of Beirut, Beirut,
Lebanon
Full list of author information is available at the end of the article
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
El-Jardali et al. Health Research Policy and Systems (2018) 16:38
https://doi.org/10.1186/s12961-018-0318-9
low- and middle-income countries (LMICs), can assume
a proactive and leading role in achieving the SDGs. This
is particularly relevant in light of the latest United
Nations report showing that the rate of progress in
many areas of the SDGs is far slower than needed to
meet the targets by 2030 [2].
To help universities accelerate action on the SDGs, the
Sustainable Development Solutions Network Australia/Pa-
cific published a practical guide that provides an overview
of how universities can contribute to implementing the
SDGs [5]. This commentary further draws on this discus-
sion and puts forward the centrality of university-led part-
nerships with governments and communities to achieve
the SDGs. It first makes the case for institutionalising uni-
versity partnerships with governments and communities,
and then proceeds with discussing the benefits of such
partnerships for achieving the SDGs.
The case for sustainable partnerships with the
government and community
Fostering partnerships with governments and communi-
ties is gaining increased prominence as the mission of
universities is gradually moving beyond the tradition of
education and research towards a third missionrelated
to their ability to partner with governments and
communities to achieve societal impact [6,7]. Increas-
ingly, universities are engaging with renowned inter-
national institutions, governments and community
members. However, with few exceptions, these interac-
tions are often ad-hoc, short-lived (e.g. for a project) or
unsustainable (e.g. based on memoranda of understand-
ing). They are not publicised as clearly, broadly and
directly as needed, with unclear portals of access for
governments and communities into universities. The
situation is exacerbated in LMICs, where universities
are grappling with the challenges of expanding
research and academic capacity and fostering quality,
while maintaining equitable access and relevance to
economy and policy-making [8,9]. In many instances,
governments are not aware of the large and relevant
knowledge base and expertise residing within univer-
sities, and academics do not perceive governments as
partners in or users of their knowledge. Consequently,
the potential of each partner is not being harnessed
to the fullest.
What is needed are long-term and sustainable
strategic partnerships to bring universities, govern-
ments and the communities they serve together in
addressing pressing challenges and transforming
societies [7,10](Fig.1).
Fig. 1 Benefits of university partnerships with governments and communities
El-Jardali et al. Health Research Policy and Systems (2018) 16:38 Page 2 of 5
Institutionalising partnerships with the
government and community
Building long-term and sustainable partnerships is a
non-trivial issue and requires investment and mainten-
ance [11]. While the role of universities in cross-sectoral
partnerships for addressing broad social challenges
remains under-researched, universities will need to tailor
their partnership approach to their own context and
learn from their own experiences [12,13]. Nonetheless,
lessons learned from implementing cross-sectoral part-
nerships suggest that trust and transparency on motiva-
tions for collaboration among partners, clarity on
mutual benefits, shared objectives and long-term com-
mitments are key for effective partnerships [13,14].
Additionally, experiences of universities worldwide, both
public and private, suggest that institutionalising part-
nerships with the government and community helps to
build transparent and sustainable relationships [15]. For
example, in Uganda, cross-sectoral collaborations failed
to carry the development agenda forward when long-
term and institutionalised partnerships with academic
institutions were not considered early on, whereas part-
nerships with the private sector, government and civil
society led by the Uganda National Academy of Sciences
a stable and apolitical organisation of academics has
shown potential to drive coordinated action on the
SDGs [14].
The SDGs provide a unique opportunity for univer-
sities and the scientific community in general to re-
interpret institutional strategies and determine the struc-
tures and mechanisms needed to strengthen engagement
with governments and communities. An overview of
universities seeking to institutionalise engagement found
that these have primarily focused on aspects of institu-
tional structure and culture traditionally associated with
sustainability, namely infrastructure, curricular reform,
funding, leadership and policies [11,15]. Community-
engaged universities also manifest extensive involvement
of executive leadership and embed the engagementin
institutional planning [11]. While a variety of institu-
tional structures to support engagement have been cited,
a pervasive trend among universities has been through
establishing centralised entities, such as a Government
and/or Community Relations Office, responsible for a
whole-of-university approach to coordinating and orga-
nising relations with the government and community.
Depending on institutional context, oversight of the en-
tity responsible for engagement can be conducted by ex-
ecutives from both the university and the government
[6]. A collaborative governance structure would enhance
opportunities for exchange and integration across both
portfolios advances needed to address the SDGs. Insti-
tutional mechanisms, such as incentives and clear guid-
ance, should support faculty engagement efforts as well
as promote accountability for such engagement. For
instance, some universities have adjusted their faculty review
processes to take into account engagement activities [16].
Strengthened university partnerships with govern-
ments and communities can largely contribute to solving
cross-sectoral and systemic health challenges. These
include addressing the determinants of health, such as
poverty and environmental factors, for reducing non-
communicable diseases, exploring effective policies and
strategies for universal health coverage in resource-
limited settings, and adapting implementation strategies
to national contexts [1719]. Importantly, given the
interconnectedness of health with other SDGs, strength-
ened partnerships can place universities in a unique
position to push for incorporating health in all policies
as a way to bring better integration and coherence to the
SDGs. In fact, health in all policieshas been positioned
as an essential tool for acting on the SDGs [20,21].
Institutionalised partnerships within universities can
facilitate engagement with governments and communi-
ties at different levels to achieve the SDGs, as described
below.
Play a lead role in strengthening the sciencepolicy
interface
Universities have the capacity to generate, translate and
disseminate knowledge relevant to achieving the SDGs.
They can work with policy-makers and other stake-
holders to identify policy priorities/problems, assess pol-
icy options, implement solutions and evaluate policies.
Importantly, they can help translate the SDGs into
measurable and country-specific targets by actively
matching academic capital with public policy priorities
and making knowledge and resources readily available to
the government and community.
Universities can engage in collaborative knowledge
generation alongside other stakeholders leading to
knowledge co-production or co-creation, which has the
potential to increase societal impact of research through
dynamic, locally adaptive partnerships, power sharing
and ongoing conflict resolution [22]. They can also en-
gage in reciprocal rotations, secondments, policy fellow-
ships and internships with the government and
community to encourage experiential learning and trans-
lational research.
Provide neutral platforms for cross-sectoral dialogue
Universities can initiate and facilitate dialogue across mul-
tiple actors, including government, private sector, aca-
demic and scientific community, civil societies and the
public. Dialogue can help ensure commitment to and
strengthen implementation of the SDGs, as well as pro-
mote the political accountability needed to attain them.
El-Jardali et al. Health Research Policy and Systems (2018) 16:38 Page 3 of 5
Support integrated and coherent policies and actions for
SDGs
While there is a general consensus on the importance of
policy coherence, efforts to achieve this tend to stall at
the implementation phase. The interconnectedness of the
SDGs provides an opportunity for universities to deepen
understanding of implementation considerations for ef-
fective and coherent policies [3]. Universities can catalyse
actions in this area by conducting analyses to identify pol-
icy coherence issues, enhancing understanding of connec-
tions and trade-offs for successful SDG implementation,
and developing new metrics to facilitate integrated moni-
toring. Universities can also contribute to advancing the
fields of systems thinking and planetary health through
conducting integrated, transdisciplinary and context-
specific research to strengthen understanding of managing
interactions between environmental and human health.
This is especially pertinent to LMICs, where weak regula-
tion for sustainable consumption and production may
have critical health consequences [3,23,24]. Importantly,
universities can actively champion new governance mech-
anisms that promote cross-sectoral collaborations and
policy coherence.
Get involved in the political process
Universities can organise, synergise and coordinate
lobbying and advocacy activities to influence and shape
public policy, particularly with regards to the SDGs. At
the same time, governments and other key players
should ensure that universities are central in discussions
on SDGs.
Strengthen transdisciplinary learning and educational
interactions
Universities are responsible for training and shaping the
future leaders of sustainable development. By integrating
the SDGs into curricula, they can provide students with
the knowledge and skills needed to address them [5].
Moreover, they can establish educational programmes
that emphasise interdisciplinary learning and promote
multidisciplinary, systems approaches to solving the
increasingly complex challenges facing societies today.
For instance, achieving health-related SDGs in LMICs re-
quires professionals proficient in designing and evaluating
cross-cutting interventions within resource-constrained
settings, developing innovative solutions and advocating
for partnerships [19].
Demonstrate commitment to effective engagement and
impact
Universities have the capacity and capability to map,
track and systematically document efforts to link re-
search to policy and practice. They can establish
meaningful frameworks and metrics for identifying,
measuring and reporting on the right indicators in a
valid way. Evaluating the impact of these efforts enables
demonstration of commitment and progress, which are
critical for learning and improvement, promoting trans-
parency and sustaining partnerships.
Conclusions
Three years into the SDG discussions, the pace of pro-
gress has not been adequate. There is still a clear discon-
nect between governments, academic institutions and
other key actors. The risk of an SDG fatiguemay ultim-
ately manifest in reverting to silo approaches to
development.
To avoid this, a necessary starting point would be to
steer the debate away from whether universities could
transcend institutional boundaries and be part of the
transformation of societies, to discussing how they
should lead the latter. This would also require a shift in
focus from data collection and monitoring of SDG pro-
gress to actively shaping better policies and actions in
support of the SDGs. Universities need to embrace their
changing roles and their unique position of influence. In
parallel, governments and other partners need to
acknowledge the role of research, data and knowledge in
informing the SDGs, and the potential of academia to
integrate different evidence ecosystems and disciplines
for successful implementation of the SDGs.
A change in mindsets and culture is needed in both
academia and government if we are to rise up to the glo-
bal challenge. This is a call to initiate the dialogue. Let
us start the conversation today so that we can achieve
the SDGs by 2030.
Abbreviations
LMICs: low- and middle- income countries; SDGs: sustainable development
goals
Authorscontributions
FEJ was involved in the conceptualisation and writing of the manuscript. NA
and RF were involved in the writing and revision of the manuscript. All
authors read and approved the final manuscript.
Competing interests
The authors declare that they have no competing interests.
PublishersNote
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
Author details
1
Department of Health Management and Policy, Faculty of Health Sciences,
American University of Beirut, Beirut, Lebanon.
2
Knowledge to Policy (K2P)
Center, American University of Beirut, Beirut, Lebanon.
3
Center for Systematic
Reviews on Health Policy and Systems Research (SPARK), American University
of Beirut, Beirut, Lebanon.
El-Jardali et al. Health Research Policy and Systems (2018) 16:38 Page 4 of 5
Received: 2 February 2018 Accepted: 24 April 2018
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El-Jardali et al. Health Research Policy and Systems (2018) 16:38 Page 5 of 5
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Dedicated to designing and organizing student-centered work, we highlight the Geomatics Engineering Students’ Association of Nepal (GESAN)’s collaborative effort to create training, internship, and job opportunities for the student members and alumni and with local institutions. Through putting into play a cycle of leadership, chapter activities find a sustainable way to continue to support SDG 8 Decent Work and Economic Growth and SDG 9 Industry, Innovation, and Infrastructure by preparing students to navigate newer applications of geospatial technology and tools. This work extends beyond campus and into the local community where we have trained secondary school students in map literacy – planting seeds of future leadership.
... The network leverages collaborations to invest in student initiatives, which has resulted in the creation of a movement of Digital Humanitarians within this academic space . "Universities are uniquely placed to lead the cross-sectoral implementation of the SDGs, providing an invaluable source of expertise in research and education on all sectors of the SDGs, in addition to being widely considered as neutral and influential players," according to El-Jardali et al. (2018). ...
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Most volumes that cover the topic of sustainability in terms of youth development are written by non-youth authors. Moreover, most are written by non-majoritarian, entrenched academic scholars. This book instead puts forward the diverse voices of students and recent graduates in countries where YouthMappers works, all over the world. 68 Authors from 25 countries cover topics that range from water, agriculture, food, to waste, education, gender, climate action and disasters from their own eyes in working with data, mapping, and humanitarian action, often working across national boundaries and across continents. To inspire readers with their insights, the chapters are mapped to the United Nations 17 Sustainable Development Goals (SDGs) in ways that connect a youth agenda to a global agenda. OPEN ACCESS https://link.springer.com/book/10.1007/978-3-031-05182-1
... The 2030 Agenda assigns a leading role to higher education institutions [5], given their work in generating and disseminating knowledge and their outstanding role in society [6]. These institutions are an invaluable source of research and education expertise across all SDG sectors and are considered natural and influential actors that promote the growth of partnerships with governments and communities [7]. There is, therefore, a consensus in the literature on the crucial role of higher education institutions in global efforts to achieve sustainability [8][9][10]. ...
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Universities are a key element in preventing any form of discrimination. Therefore, the United Nations 2030 Agenda recognizes their role through goal 4 regarding the quality of education. The 2030 agenda also includes goals 5 and 10, regarding gender equity and reducing inequalities as cross-cutting elements to boost social inclusion. The purpose of this research is to carry out a multivariate and dynamic analysis of the most outstanding universities in the global list of the THE Impact Rankings, which is the only tool that classifies these institutions in terms of the sustainable development goals (SDGs) to study how they are positioned in the indicators related to inequality. We also examine its evolution in the last three years and the relationship between goals 4, 5, and 10. The results show that less than half of the leading universities in sustainability carry out an active social inclusion policy. Additionally, most of them underwent significant changes in their trajectories to approach the indicator of gender equity. The research suggests there is still a long way to go to achieve social justice.
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While sustainability is at the centre of many government agendas, there is a great risk of entrusting strategic decisions to those lacking in sustainability expertise. It is therefore necessary to ensure that universities are the green engines of sustainable communities. The present study administered a questionnaire to students enrolled in a Management Engineering programme at an Italian university, to collect their perceptions of and opinions on sustainability and energy issues. Students completed the questionnaire twice: once prior to beginning and once at the end of term. The results showed that students held more sustainable attitudes at the end of term, and perceived sustainable education and youth confidence as the building blocks of future society. They also observed that decarbonisation of the Italian energy system and national energy independence would require the significant development of renewable systems and interventions to promote energy efficiency. In addition, they recognised subsidies for green production, energy communities, differentiated waste collection and professional skills training as crucial. The sustainable university should support younger generations by encouraging student engagement in real-world projects and the development of long-term, structured teacher–student relationships.
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Health Research and Policy Systems (HARPS) has gone from strength to strength since it was established in 2003. As new Editors-in-Chief, we look forward to a bright future for HARPS, and we would like to start a conversation with you, HARPS readers, authors, editors and others, about how HARPS can best support ongoing progress and debate on evidence-informed health research policy and systems, particularly in developing countries. As a starting point for discussion, we would like to highlight three areas that we are passionate about, namely supporting an integrated community of researchers and policy-makers; building a focus on how health research and policy systems can support achievement of the Sustainable Development Goals; and strengthening our commitment to communicating and disseminating the work published in HARPS. We invite you to contribute your thoughts, ideas and suggestions on the future of HARPS, as we work together towards an evidence-informed future.
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The 2030 Agenda for Sustainable Development came into force in January 2016 as the central United Nations (UN) platform for achieving ‘integrated and indivisible’ goals and targets across the three characteristic dimensions of sustainable development: the social, environmental and economic. We argue that, despite the UN adoption of the Sustainable Development Goals (SDGs), a framework for operationalising them in an integrated fashion is lacking. This article puts forth a framework for integrating health and well-being across the SDGs as both preconditions and outcomes of sustainable development. We present a rationale for this approach, and identify the challenges and opportunities for implementing and monitoring such a framework through a series of examples. We encourage other sectors to develop similar integrating frameworks for supporting a more coordinated approach for operationalising the 2030 Agenda for Sustainable Development.
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Background Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910) emphasized the centrality of preventive medicine, sanitation, and public health measures in health professional education. The Alma Ata Declaration on Primary Health Care (PHC) in 1978 was a critical milestone, especially for low and middle-income countries (LMICs), conceptualizing a close working relationship between PHC and public health measures. The Commission on Social Determinants of Health (2005–2008) strengthened the case for SPHs in LMICs as key stakeholders in efforts to reduce global health inequities. This scoping review groups text into public health challenges faced by LMICs and the role of SPHs in addressing these challenges. Main text The challenges faced by LMICs include rapid urbanization, environmental degradation, unfair terms of global trade, limited capacity for equitable growth, mass displacements associated with conflicts and natural disasters, and universal health coverage. Poor governance and externally imposed donor policies and agendas, further strain the fragile health systems of LMICs faced with epidemiological transition. Moreover barriers to education and research imposed by limited resources, political and economic instability, and unbalanced partnerships additionally aggravate the crisis. To address these contextual challenges effectively, SPHs are offering broad based health professional education, conducting multidisciplinary population based research and fostering collaborative partnerships. SPHs are also looked upon as the key drivers to achieve sustainable development goals (SDGs). Conclusion SPHs in LMICs can contribute to overcoming several public health challenges being faced by LMICs, including achieving SDGs. Most importantly they can develop cadres of competent and well-motivated public health professionals: educators, practitioners and researchers who ask questions that address fundamental health determinants, seek solutions as agents of change within their mandates, provide specific services and serve as advocates for multilevel partnerships. Funding support, human resources, and agency are unfortunately often limited or curtailed in LMICs, and this requires constructive collaboration between LMICs and counterpart institutions from high income countries.
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Policy points: Co-creation-collaborative knowledge generation by academics working alongside other stakeholders-is an increasingly popular approach to aligning research and service development. It has potential for "moving beyond the ivory towers" to deliver significant societal impact via dynamic, locally adaptive community-academic partnerships. Principles of successful co-creation include a systems perspective, a creative approach to research focused on improving human experience, and careful attention to governance and process. If these principles are not followed, co-creation efforts may fail. Context: Co-creation-collaborative knowledge generation by academics working alongside other stakeholders-reflects a "Mode 2" relationship (knowledge production rather than knowledge translation) between universities and society. Co-creation is widely believed to increase research impact. Methods: We undertook a narrative review of different models of co-creation relevant to community-based health services. We contrasted their diverse disciplinary roots and highlighted their common philosophical assumptions, principles of success, and explanations for failures. We applied these to an empirical case study of a community-based research-service partnership led by the Centre of Research Excellence in Quality and Safety in Integrated Primary-Secondary Care at the University of Queensland, Australia. Findings: Co-creation emerged independently in several fields, including business studies ("value co-creation"), design science ("experience-based co-design"), computer science ("technology co-design"), and community development ("participatory research"). These diverse models share some common features, which were also evident in the case study. Key success principles included (1) a systems perspective (assuming emergence, local adaptation, and nonlinearity); (2) the framing of research as a creative enterprise with human experience at its core; and (3) an emphasis on process (the framing of the program, the nature of relationships, and governance and facilitation arrangements, especially the style of leadership and how conflict is managed). In both the literature review and the case study, co-creation "failures" could often be tracked back to abandoning (or never adopting) these principles. All co-creation models made strong claims for significant and sustainable societal impacts as a result of the adaptive and developmental research process; these were illustrated in the case study. Conclusions: Co-creation models have high potential for societal impact but depend critically on key success principles. To capture the nonlinear chains of causation in the co-creation pathway, impact metrics must reflect the dynamic nature and complex interdependencies of health research systems and address processes as well as outcomes.
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This paper addresses the topic of this special symposium issue: how to enhance the impact of cross-sector partnerships. The paper takes stock of two related discussions: the discourse in cross-sector partnership research on how to assess impact and the discourse in impact assessment research on how to deal with more complex organizations and projects. We argue that there is growing need and recognition for cross-fertilization between the two areas. Cross-sector partnerships are reaching a paradigmatic status in society, but both research and practice need more thorough evidence of their impacts and of the conditions under which these impacts can be enhanced. This paper develops a framework that should enable a constructive interchange between the two research areas, while also framing existing research into more precise categories that can lead to knowledge accumulation. We address the preconditions for such a framework and discuss how the constituent parts of this framework interact. We distinguish four different pathways or impact loops that refer to four distinct orders of impact. The paper concludes by applying these insights to the four papers included in this special issue.
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Earth's natural systems represent a growing threat to human health. And yet, global health has mainly improved as these changes have gathered pace. What is the explanation? As a Commission, we are deeply concerned that the explanation is straightforward and sobering: we have been mortgaging the health of future generations to realise economic and development gains in the present. By unsustainably exploiting nature's resources, human civilisation has fl ourished but now risks substantial health eff ects from the degradation of nature's life support systems in the future. Health eff ects from changes to the environment including climatic change, ocean acidifi cation, land degradation, water scarcity, overexploitation of fi sheries, and biodiversity loss pose serious challenges to the global health gains of the past several decades and are likely to become increasingly dominant during the second half of this century and beyond. These striking trends are driven by highly inequitable, ineffi cient, and unsustainable patterns of resource consumption and technological development, together with population growth. We identify three categories of challenges that have to be addressed to maintain and enhance human health in the face of increasingly harmful environmental trends. Firstly, conceptual and empathy failures (imagination challenges), such as an over-reliance on gross domestic product as a measure of human progress, the failure to account for future health and environmental harms over present day gains, and the disproportionate eff ect of those harms on the poor and those in developing nations. Secondly, knowledge failures (research and information challenges), such as failure to address social and environmental drivers of ill health, a historical scarcity of transdisciplinary research and funding, together with an unwillingness or inability to deal with uncertainty within decision making frameworks. Thirdly, implementation failures (governance challenges), such as how governments and institutions delay recognition and responses to threats, especially when faced with uncertainties, pooled common resources, and time lags between action and eff ect. Although better evidence is needed to underpin appropriate policies than is available at present, this should not be used as an excuse for inaction. Substantial potential exists to link action to reduce environmental damage with improved health outcomes for nations at all levels of economic development. This Commission identifi es opportunities for action by six key constituencies: health professionals, research funders and the academic community, the UN and Bretton Woods bodies, governments, investors and corporate reporting bodies, and civil society organisations. Depreciation of natural capital and nature's subsidy should be accounted for so that economy and nature are not falsely separated. Policies should balance social progress, environmental sustainability, and the economy. To support a world population of 9-10 billion people or more, resilient food and agricultural systems are needed to address both undernutrition and overnutrition, reduce waste, diversify diets, and minimise environmental damage. Meeting the need for modern family planning can improve health in the short termeg, from reduced maternal mortality and reduced pressures on the environment and on infrastructure. Planetary health off ers an unprecedented opportunity for advocacy of global and national reforms of taxes and subsidies for many sectors of the economy, including energy, agriculture, water, fi sheries, and health. Regional trade treaties should act to further incorporate the protection of health in the near and long term. Several essential steps need to be taken to transform the economy to support planetary health. These steps include a reduction of waste through the creation of products that are more durable and require less energy and materials to manufacture than those often produced at present; the incentivisation of recycling, reuse, and repair; and the substitution of hazardous materials with safer alternatives. Despite present limitations, the Sustainable Development Goals provide a great opportunity to integrate health and sustainability through the judicious selection of relevant indicators relevant to human wellbeing, the enabling infrastructure for development, and the supporting natural systems, together with the need for strong governance. The landscape, ecosystems, and the biodiversity they contain can be managed to protect natural systems, and indirectly, reduce human disease risk. Intact and restored ecosystems can contribute to resilience (see panel 1 for glossary of terms used in this report), for example, through improved coastal protection (eg, through wave attenuation) and the ability of fl oodplains and greening of river catchments to protect from river fl ooding events by diverting and holding excess water. The growth in urban populations emphasises the importance of policies to improve health and the urban environment, such as through reduced air pollution, increased physical activity, provision of green space, and urban planning to prevent sprawl and decrease the magnitude of urban heat islands. Transdisciplinary research activities and capacity need substantial and urgent expansion. Present research limitations should not delay action. In situations where technology and knowledge can deliver win-win solutions and co-benefi ts, rapid scale-up can be achieved if researchers move ahead and assess the implementation of potential solutions. Recent scientifi c investments towards understanding non-linear state shifts in ecosystems are very important, but in the absence of improved understanding and predictability of such changes, eff orts to improve resilience for human health and adaptation strategies remain a priority. The creation of integrated surveillance systems that collect rigorous health, socioeconomic, and environmental data for defi ned populations over long time periods can provide early detection of emerging disease outbreaks or changes in nutrition and non-communicable disease burden. The improvement of risk communication to policy makers and the public and the support of policy makers to make evidence-informed decisions can be helped by an increased capacity to do systematic reviews and the provision of rigorous policy briefs. Health professionals have an essential role in the achievement of planetary health: working across sectors to integrate policies that advance health and environmental sustainability, tackling health inequities, reducing the environmental impacts of health systems, and increasing the resilience of health systems and populations to environmental change. Humanity can be stewarded successfully through the 21st century by addressing the unacceptable inequities in health and wealth within the environmental limits of the Earth, but this will require the generation of new knowledge, implementation of wise policies, decisive action, and inspirational leadership.
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Complex problems of urban health and wellbeing cause millions of premature deaths annually and are beyond the reach of individual problem-solving capabilities. Collective and artificial intelligence (CI + AI) working together can address the complex challenges of urban health.
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A game changer in global health In September 2015, nearly 200 nations adopted the 17 sustainable development goals (SDGs) as a transformative, universal framework to address three interwoven dimensions of our global existence—people, planet, and prosperity.1 They are predicated on the notion that sustainability is not just an aspiration but a necessity. However, by substantially expanding on the scope and targets of their predecessors (the millennium development goals), the SDGs have set a high bar. To achieve them, we will need collective action to create new knowledge, share and broker knowledge, and implement insights through working with many sectors and diverse global health policy stakeholders. With this in mind, 60 global health policy think tanks from around the world met in Geneva in November 2015 to explore the role that think tanks and academic institutions have in implementing the SDGs. Although only SDG3 focuses primarily on health, many other development goals, including those that relate to the environment, nutrition, hunger, sustainable production and consumption, agriculture, and education, also have a big effect on health. To achieve progress on human health, countries will therefore need to commit to a broad agenda of sustainable development that acknowledges and exploits the links between different goals and targets. This provides an opportunity for systems thinking: applying an ecological perspective and implementing an …