Q&A with Dr Rachel Nugent, researcher, economist and policy advisor in Noncommunicable Diseases

This week, many of the world’s leading figures are convening for the 77th session of the UN General Assembly. As part of the program of side events, Access Accelerated, its partners and RTI International will host business, health and civil society leaders for a thought-provoking dialogue and roundtable on collective impact for NCDs.

Dr Rachel Nugent, Vice President of the Global Noncommunicable Diseases team at RTI International, a leading research institute addressing the world’s most critical challenges, will be moderating the event. She has been an important thinker and voice in guiding and informing policy makers on global development and NCDs for the better part of three decades.

Dr Nugent’s storied career includes an associate professorship of global health at the University of Washington and a leading role at the Disease Control Priorities Network. Ahead of this week’s event, she took time out of her busy schedule to share why she’s optimistic about the progress that has been made on NCDs, the importance of being open to learning, and how measuring the intangible is a golden opportunity for the global development community.

In 2017 you co-wrote the article, Addressing NCDs where you say: “…a new day is coming,” referencing the inclusion of NCDs in the Sustainable Development Goals (SDGs). Five years later, can you share your reflection of the progress that has been made in addressing NCDs? Do you still feel the same sense of optimism?

Progress in regard to the SDGs themselves, or the target for NCDs, has not been great. It’s not been as much as people would like to see. So, there are many countries that are not going to meet that target. That said, I think we all know that an indicator is just an indicator. It doesn’t tell many other parts of the story of NCDs and the response to them and the capacity to respond. We’ve made tremendous amounts of progress on those aspects.

I would say I am still pretty optimistic. One of our most powerful policy levers is to use taxes to reduce people’s consumption of unhealthy products. Of course, we have a lot of experience with taxing tobacco and there has been a lot of debate among economists—and I’m one of those economists—about applying taxes on some of the other NCD-related risks, like sugar, sweetened beverages, or unhealthy foods. We have built evidence that it can work to tax sugar and sweetened beverages for quite a few countries, and we have that evidence from very rigorous evaluation.

That’s not going to change everything overnight, and that’s not the only tool that we have, but getting consensus, getting evidence on how to move forward on that is really quite big. I’m also grateful for the kind of work that has been done by researchers, by advocacy groups, by policy makers, to advance us from where we used to be.

At Access Accelerated, we are convinced of the power of partnerships to effectively respond to some of the most pressing global challenges. With your 30+ years of experience working in global development, why do you believe multi-stakeholder collaboration is so critical? 

I think multi-stakeholder collaboration has always been important, but it’s more important now for several reasons. One is that we have learned that none of the issues that we care about in global development are isolated issues. We used to think that for a long time: we thought about poverty as poverty and health as health. Infectious diseases, transportation needs, energy needs, environmental issues and agricultural issues have been in their own world.

We now know better than that. It’s a complex ecosystem and multi-stakeholder engagement recognizes that and respects it. It makes the efforts much stronger.

It’s a complex ecosystem and multi-stakeholder engagement recognizes that and respects it.

I think of it like financial diversification. If you have a portfolio and you are making investments for retirement, you are told by the financial advisors, “You need to diversify.” That’s what makes a strong portfolio. It’s the same thing with stakeholders and trying to solve a complex problem: diversification makes us stronger. We’ve come a long way in our understanding, but that doesn’t mean that we’ve come as far as we need in learning how to do it. But we know that it has got to be the way things need to be done.

Over the past year, RTI International has worked with Access Accelerated to design a framework to better understand its investment in collective action. What drew you to this project?

First of all, I have a lot of respect for the Access Accelerated partners who are involved. I knew they would do high-quality work.

Second, I do feel that there is a learning agenda here; the significant dedication of time and resources and thinking that Access Accelerated has invested in understanding its impact and that of their partners. I saw the potential for this project to have a high impact from a learning agenda perspective. I think that’s really valuable.

The third thing is I felt like it’s so important for Access Accelerated to succeed because we still need to convince those outside the NCD world that NCD problems are solvable — that this is important. And so every effort, even if it’s a challenging effort and is something that’s new, it’s important that we show that we can succeed.

By taking these steps and moving forward, this helps to persuade others that NCDs is something that they should be interested in contributing to as well and getting involved in.

What was your approach to developing such a framework?

The first thing we did was conduct a lot of interviews with people. It’s always great to hear people talk about what they’re doing and what they are trying to do. And we talked to people both inside and outside of Access Accelerated to get perspectives on what’s going right, what’s not going so well, what we would like to be doing, what are we accomplishing. Another step was establishing credibility using the methods of MERLA [Monitoring, Evaluation, Research, Learning and Assessment].

Subsequently, through that first stage of gathering information and developing a report of what had been accomplished, we learned a lot from the partners about what needed to be adapted and that’s where we are now. So it’s been a learning process.

I just spoke with our keynote speaker for next week, Kyle Peterson, and he said, “It looks a lot like a learning collaborative to me.” And I really like that. I think that’s true.

We’ll talk more about different models of working together [at the event], but the one thing I’ve noticed about Access Accelerated is how much it tries to be sure that there is learning, a kind of thoughtful consideration and reconsideration, and that can take longer to get things done that way sometimes but what you end up with are new insights that I think will last longer because they’re not necessarily simple and obvious.

One of the outcomes of this work is the coining of the term “connective tissue” to describe the collaborative muscle that is built through trust, knowledge exchange and shared goals. Can you help us understand what exactly is connective tissue and how this concept can support us in our work in global public health, particularly NCDs?

In this context, it’s what gets created during the process of working together towards common goals. And yes, there’s tangible things that we’re measuring that get accomplished, like delivering medicines and supplies or reaching cancer patients at an earlier stage of the disease. Those are all really important and concrete, but in addition, there are things being created that are less tangible. I think of that as trust, openness, familiarity, mutuality of effort and interest. That’s connective tissue in my mind.

I think it’s important that we assign a name to it, a term to it, and we talk about it so that it doesn’t get lost.

What can attendees look forward to from the discussions at this week’s UNGA side event?

It will be a learning experience. We’re going to hear people talk thoughtfully about what has worked in the work they’re doing on NCDs and how they know that it’s worked, what they’re measuring and what they think is important to measure.

Starting with Kyle’s keynote, we’re going to think about how we can work together. Do we need to do anything differently? Should we be continuing on in the same way? Are there stages of collective action and building connective tissue and what stage are we at? What stage do we want to get to? We’ll hear both concrete examples from projects that people have been working on as well as a little bit more ideating about why it’s important to be explicit about measuring connective tissue, measuring collective action, and thinking about what it can produce.

Thank you very much, Rachel, for sharing your thoughts with us. Is there anything we haven’t picked up on that you’d like to add?

One of things we haven’t talked about is the role of the private sector. This initiative is very much driven by the private sector, and Access Accelerated is demonstrating that the private sector can partner really well with a number of different types of organizations. It’s important to recognize that the private sector is demonstrating something that I hope will be a model used more and more broadly, and that the lessons learned from Access Accelerated will be shared so that others can pick up on it and continue.

Register here to attend “Unlocking the potential for collective impact” taking place this Thursday, September 22.

For more information on RTI’s work with Access Accelerated, read the 2021 Measurement Framework Report.