Complicating The Narrative

When was the last time a health system asked people for what they needed?

Margaret Kruk joins Salma to discuss health systems and one of their key components: the experience of patients. They start their conversation with an overview of the functions and components of a health system and highlight that, similar to other service industries, healthcare needs to function for the people it serves and should check-in with these end-users. Margaret revisits her early-on experiences as a family doctor in rural Canada and in Kigoma, Tanzania, where she realized health systems were not responding to people’s needs, despite being designed as systems that should perform well. The conversation then shifts to discussing The Lancet Global Health Commission on High Quality Health Systems, a joint effort of researchers, healthcare providers and health systems decision makers, to understand what data were available to track quality and what data were missing to respond to the most relevant questions of quality healthcare practice, finding that available measures of quality did not map to patients’ outcomes.

Shifting course, Margaret and Salma explore the People’s Voice Survey, a global survey currently measuring health systems’ quality in 23 countries based on people’s perceptions and confidence in the system. Margaret highlights the importance of confidence—reflecting security and endorsement of systems that people can count on when they need it—and the differences between mental health and chronic physical conditions.

Finally, they reflect on the future of primary care, starting with a brief recount of its history and mission. They examine the role of emerging technologies, and especially artificial intelligence, on empowering patients and getting them to demand better quality of systems, considering the improvement of health systems should be a shared endeavor.

This episode will invite you to reconsider what a truly patient-centered health system looks like, and what it takes to build one.

Notes:

Acronyms used in this podcast include:

AI = Artificial Intelligence

GDP = Gross Domestic Product

QI = Quality Improvement

UK = United Kingdom

US = United States

UN = United Nations

UNDP = United Nations Development Programme

Useful resources:

Kruk ME, Gage AD, Arsenault C, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. The Lancet Global Health. 2018;6(11):e1196-e1252. doi:1016/S2214-109X(18)30386-3

Kruk ME, Pate M. The Lancet Global Health Commission on High Quality Health Systems 1 year on: progress on a global imperative. The Lancet Global Health. 2020;8(1):e30-e32. doi:1016/S2214-109X(19)30485-1

Kruk ME, Kapoor NR, Arsenault C, et al. Health system use and experience among people with poor mental health: A cross-sectional analysis of the People’s Voice Survey in 18 countries. Tang S, ed. PLoS Med. 2026;23(5):e1004745. doi:1371/journal.pmed.1004745

MAVEN-Primary Care: AI-Powered Patient-Provider Collaboration to Transform Chronic Disease Management. Digital Intelligence & Innovation Accelerator. 2026. https://di2accelerator.wustl.edu/digital-transformation-corps/2026-projects/maven-primary-care-ai-powered-patient-provider-collaboration-to-transform-chronic-disease-management/

If you have any questions or feedback, email us at healthierfutureslab@wustl.edu.

 

Host: Dr. Salma Abdalla

Editor: Zach Linhares

Producer: Catalina Melendez Contreras

Production assistant: Mateo Diaz Quiroz

Marketing and social media: Kinkini Bhaduri

Research for episode preparation: Mateo Diaz Quiroz

 

Music: Eden Avery / Melting Glass from Epidemic Sound https://www.epidemicsound.com/track/2fqOXWpHab/

 

The views and opinions expressed by the guest in this episode do not necessarily reflect those of their institution, the funders, or the podcast team.

In this last episode of the Building Better Ways of Knowing (BBWK) mini-series, Kumanan joins Salma to discuss knowledge systems and their articulations with public health practice in the global context. They begin the conversation by reflecting on knowledge systems, how they have privileged and excluded different forms of knowledge, and how they have lagged behind transformations across other dimensions of society. They then touch on Kumanan’s experience working for a meningococcal B vaccine randomized control trial (RCT) in New Zealand to depict how some forms of knowledge generation don’t reflect real-world scenarios.

They then shift course to discuss the emergence of The Alliance for Health Policy and Systems Research in 1999 and the functions it serves in the global health scenario to close the “know-do gap”: supporting high-quality research in low- and middle-income countries (LMICs), building research capacity in LMICs, and advocating for and building the field. Finally, they discuss the changing global power dynamics with increased within-country inequities and rising health sovereignty, Professor Wasi’s concept of "The triangle that moves mountains” to describe what is needed for long-lasting change, and the expected future of universities and healthcare with the rise of artificial intelligence.

This closing conversation sums up the interdisciplinary conversations hosted during this BBWK summer mini-series and invites you to comprehensively reflect on how knowledge generation intersects with real-life scenarios.

About the guest:

Kumanan Rasanathan is the Executive Director of The Alliance for Health Policy and Systems Research at the World Health Organization in Geneva, Switzerland. He is a public health physician with a strong background in health policy and systems research and extensive experience working at different levels of the World Health Organization and within the wider UN system. As part of The Alliance for Health Policy and Systems Research, Kumanan and his team lead the global learning component of the Building Better Ways of Knowing initiative.

 

Notes:

Acronyms mentioned in this episode include:

AI = Artificial Intelligence

LLM = Large Language Model

RCT = Randomized Controlled Trial

SAS = Statistical Analysis System

WHO = World Health Organization

 

Host: Dr. Salma Abdalla

Editors: Catalina Melendez Contreras

Marketing: Kinkini Bhaduri

Music: Helmut Schenker / Omnia from Epidemic Sound https://www.epidemicsound.com/music/tracks/60e14d61-23ca-4899-9c56-9a9018634986/

 

The views and opinions expressed by the guest in this episode do not necessarily reflect those of their institution, the funders, or the podcast team.

Almost nothing about how the United States government funds health research was chosen. The National Institutes of Health (NIH) began with leftover penicillin money and a letter to medical school deans. The decision to fund projects rather than people came from a foundation protecting itself during the Depression. The paperwork came from a congressman who was annoyed in 1962.

Michael Lauer spent nearly two decades at the NIH, serving as Deputy Director for Extramural Research from 2015 until 2025. He joins Salma to trace how these accidents hardened into a system that leaves scientists dependent on grants for their salaries, concentrates most of the money in a small number of hands, and does not grant most researchers independence until their mid-forties. They discuss what could be done differently, and the question that has gone unanswered since the 1940s: who should decide what science gets done.

Dr. Lauer suggests that the current situation being faced by the NIH and researchers is the result of these structural problems and highlights that while there is a crisis, it is also an opportunity to restructure funding and research incentives.

This episode asks whether the current inflection point in research funding might be the opening needed to rethink a system that was never quite designed to work.

 

Notes:

Acronyms used in this episode include:

CTSA = Clinical and Translational Science Awards

IACUCs = Institutional Animal Care and Use Committees

IRB = Institutional Review Board

MIRA = Maximizing Investigators' Research Award

NASA = National Aeronautics and Space Administration

NCI = National Cancer Institute

NHLBI = National Heart, Lung, and Blood Institute

NIAID = National Institute of Allergy and Infectious Diseases

NIGMS = National Institute of General Medical Sciences

NIH = National Institutes of Health

NSF = National Science Foundation

PCORI = Patient-Centered Outcomes Research Institute

R01 = Research Project Grant

Fact checks:

Glenn Seaborg was Chancellor of the University of California at Berkeley between 1958 and 1961

 

About the guest:

Michael Lauer is a cardiologist and physician-scientist who served as the Director of the Office of Extramural Research and the Deputy Director for Extramural Research at the National Institutes of Health (NIH) between October 2015 and February 2025. As Director for Extramural Research he led the NIH funding processes for universities, medical schools, and research organizations outside of the United States government.

 

Useful resources:

Bush V. Science, The Endless Frontier - 75th Anniversary Edition. National Science Foundation. Published online 2023. https://nsf-gov-resources.nsf.gov/2023-04/EndlessFrontier75th_w.pdf

Kratsios M. Science, A New Golden Age. Office of Science and Technology Policy; 2026. https://www.whitehouse.gov/science/

 

Host: Dr. Salma Abdalla

Editors: Catalina Melendez Contreras

Marketing: Kinkini Bhaduri

Music: Eden Avery / Melting Glass from Epidemic Sound https://www.epidemicsound.com/track/2fqOXWpHab/

 

The views and opinions expressed by the guest in this episode do not necessarily reflect those of their institution, the funders, or the podcast team.

Sara and Darren join Salma to discuss Civic City’s community-first model. They start the conversation by exploring how Civic City uses knowledge, narrative, and design to co-create solutions with communities. To make this tangible, they delve into the Food City STL initiative, which started off by deep community listening and led to a city resolution declaring food as a human right.

Pertaining to the role of academic research and knowledge generation, Sara and Darren talk about their collaboration with University of Missouri St. Louis, which began as something transactional and evolved to a true co-creation partnership. They also highlight the value of data, acknowledging that “data is gold”, and argue that communities sit on valuable knowledge that institutions often extract without returning value instead of sharing the findings back with the communities. Finally, they emphasize that knowledge, agency, and capacity are the three things needed to move from knowledge to action, and underscore the importance of creating new spaces to foster interaction and collaboration between academia, journalism, and community. However, they note that these interactions must acknowledge that knowledge generation and co-creation processes are scalable, but the solutions that result from them are not.

If you’ve wondered what true community involvement in research looks like, and how it can evolve to ensure true co-creation of knowledge, this episode will give you concrete ideas to help catalyze this shift.

 

About the guests:

Darren Jackson is Founder of Civic City, a community-first civic venture studio in St. Louis that works with communities, industry, and government to build solutions and opportunities to public challenges. He is a civic innovation leader specializing in human-centered design, applying data, empathy, and creative problem-solving to help communities and institutions build cities for all. He previously served as Executive Sourcing Partner and Advisor to Meta, Adobe, Block, and IDEO, aiming to bridge innovation with civic impact.

Sara Bannoura is Co-Founder of Civic City, where she helps lead the Food for All campaign. She is a journalist and civic systems leader who explores how storytelling, community knowledge, and lived experience shape public systems and policy. She previously served as senior producer in local television news, produced a feature documentary on the fentanyl crisis in St. Louis, and led coverage during the COVID-19 pandemic and reported daily on public health data and disparities while documenting the lived realities of communities navigating unequal access to essential resources.

 

Notes:

Acronyms mentioned in this episode include:

CDC = Centers for Disease Control and Prevention

CEO = Chief Executive Officer

COO = Chief Operating Officer

DRC = Democratic Republic of Congo

USML = University of Missouri, St Louis

 

Useful resources:

1.For the Sake of All: A Report on the Health and Well-Being of African Americans in St. Louis and Why It Matters for Everyone. Washington University in St. Louis and Saint Louis University; 2015. https://bpb-us-e2.wpmucdn.com/sites.wustl.edu/dist/3/1454/files/2018/06/FSOA_report_2-17zd1xm.pdf

 

Host: Dr. Salma Abdalla

Editors: Catalina Melendez Contreras

Marketing: Kinkini Bhaduri

Music: Helmut Schenker / Omnia from Epidemic Sound https://www.epidemicsound.com/music/tracks/60e14d61-23ca-4899-9c56-9a9018634986/

 

The views and opinions expressed by the guest in this episode do not necessarily reflect those of their institution, the funders, or the podcast team.

This episode is a re-run of the Ideas Matter podcast episode “The Future of Higher Education” hosted by Dean Sandro Galea—Vice Provost for Interdisciplinary Initiatives at WashU and Co-Director of the Building Better Ways of Knowing initiative—in conversation with Professor Mitchell Stevens. The original episode was released by Ideas Matter on May 26, 2026.  

In this episode, Dean Galea and Dr. Stevens discuss the current state of higher education, and the challenges and opportunities that result from thismoment of institutional change and fourth industrial revolution.  

Looking back, Dean Galea and Dr. Stevens examine the values that have sustained higher education throughout its history, the historical role of education as a service, economic, civic and moral provider to the nation, and the main pathway towards economic mobility. They highlighted that the majority of the nation does not access or complete college, which has resulted in the economic, cultural, and political splits that have contributed to current polarization levels. They unpack challenges related to unaffordability, unrestrained costs, and the student-debt crisis; the moral/civic question of who should be responsible for the lifelong employability of American people; the threats posed to current higher education by the shrinking pool of youth and young adults, technological leaps, and the “casualization” of faculty. 

Looking forward, they discuss the challenge that AI poses to the long-held idea that expert knowledge lives irreplaceably in human minds and Dr. Stevens suggests that a paradigm shift, moving away from school-centric logics of human capital towards new hybrid models and the investment in people’s capabilities across the life course, should be adopted. 

If you wonder what higher education will look like amidst the fourth industrial revolution catalyzed by AI and the demographic shift, this episode will offer a clear framework to understand how we got here and how things might unfold.  

About the guest:  

Mitchell Stevens is Professor at the Graduate School of Education and Faculty Affiliate at the Institute for Human-Centered Artificial Intelligence (HAI) at Stanford University, where he also convenes the Pathways Network and the Futures Project on Education and the Learning Society. His research focuses on educational sequences, lifelong learning, alternative educational forms, and the formal organization of knowledge. 

 

Notes:  

Acronyms mentioned in this episode include:  

- AI = Artificial intelligence  

- K-12 = Kindergarten through 12th grade  

- MOOC = Massive open online course  

 

Host: Dr. Salma Abdalla  

Editors: Ryan Rhea and Catalina Melendez Contreras  

Marketing: Kinkini Bhaduri  

Music: Helmut Schenker / Omnia from Epidemic Sound https://www.epidemicsound.com/music/tracks/60e14d61-23ca-4899-9c56-9a9018634986/

 

The views and opinions expressed by the guest in this episode do not necessarily reflect those of their institution, the funders, or the podcast team.