Natasha Thambirajah has joined UBC’s School of Public Policy and Global Affairs (SPPGA) as Adjunct Professor, as part of the 2022 SPPGA Practitioner Fellowship program.
In the spirit of facilitating knowledge exchange, strengthening community ties, and building an ethos of practice into our professional graduate programs, SPPGA’s Practitioner Fellowship program hosts several practitioners in residence for periods of four to eight months. Fellows are professionals with leadership experience in public policy, international development, global affairs and/or government, across a variety of issue areas and sectors.
SPPGA Practitioner Fellow Natasha Thambirajah is a third-generation public servant and has worked for the Province of BC since 2006. Over the past 15 years, she has led nationally recognized examples of transformative, citizen-centred public policy, including the prize-winning BC Services Card and the modernization of gender identity expression on government-issued identification.
In her current role as Director, Digital Health Policy, Natasha works closely with senior leadership and key partners to lead the development of provincial standards, policies and guides for virtual care and digital health. This work has been a critical part of the province’s response to the COVID-19 pandemic and sets a foundation for digitally transforming the way we deliver health care in British Columbia.
Natasha stated: “I am delighted to bring the previous academic experience as well as my applied expertise in sector-wide public policy to the SPPGA community. I am particularly looking forward to offering a workshop this spring via SPPGA and the UBC School of Population and Public Health as well as several guest lectures. I am honoured to be part of an award-winning and internationally recognized faculty that will no doubt reconnect me with my academic roots, guide me in the ways of how pedagogy has evolved since I last practiced it, and help me refine my interdisciplinary approach to learning about, teaching and producing public policy.”
In welcoming Natasha, SPPGA Director Allison Macfarlane said: “We are looking forward to collaborating with Natasha Thambirajah in her work on public health and are excited to see the practical experience she will share with our faculty and students. We look forward to helping Professor Thambirajah establish a new area of expertise to take back to her important policy work.”
In addition to advancing an individual research or professional project, SPPGA Practitioner Fellows can expect to pursue student and community engagement, research and collaboration, and teaching and learning, and return to the workplace with new expertise to inform their work.
We sat down with Natasha to learn more about her background and what she is most excited about in joining the SPPGA community:
SPPGA: Could you please tell us a bit about yourself and your professional background?
I’ve been with the public service in British Columbia for over 15 years with a focus on public policy and strategy setting.
I’ve been really involved in spaces in government with digital transformation. It’s really not about the idea of bringing in technology, it’s about rethinking the way we deliver services to people, rethinking the way we do our jobs and how we collaborate with each other. The technology should always serve a purpose, it’s not a purpose unto itself.
SPPGA: You have led groundbreaking policies for initiatives such as modernizing gender identity expression on government-issued identification. What have been some of the most meaningful moments in your career?
The modernization of gender identity expression on government-issued identification was an extraordinary moment, not only in British Columbia but in Canadian history. We were the first province to change our laws to abolish the requirement for reassignment surgery. This was ten years ago – a really challenging time when the subject of transgender rights was not topical.
This change required multi-partner cooperation across government: driver licensing, biostatistics agency, the Ministry of Health for the Care Card, as well as the Ministry of Citizens’ Services, which is the owner now of the BC Services Card.
“I think what’s extraordinary about this is that when you think about public policy making, this is a classic example of how you can initiate institution-led change.”
And so the policy continued to evolve and several years ago we introduced the non-binary marker. And recently, we finally got rid of needing to have a physician or some kind of medical professional sign off on you talking about what your gender is, because gender isn’t a medical category, it is a social, cultural one. What’s really beautiful about good public policy is that if you set the right foundation in place, it will get to where it needs to go.
I’ve been lucky in my career to have a mix of doing public policy but also the practical application of it. I’ve had the privilege of running the Home Health Monitoring (HHM) program, which I won the PwC Accelerator Award for a couple years ago, in the space of innovation. This represented the blending of policy and actual application into service delivery. Home health monitoring is an example of what we call remote patient monitoring.
About 44% of the Canadian population over the age of 20 has one or more chronic disease. We want to help people better self-manage their chronic conditions. It’s been a cool success. For example, if you live with COPD and it’s not managed well, you might experience a stress-induced attack brought on by an incident and you might end up in the ER. The HHM helps improve people’s quality of life.
SPPGA: What policy issues keep you up at night and why?
When I’m solving really complex problems, I actually dream about them. And then I wake up at three in the morning with an answer, and I have to write it down and tell my staff.
Digital policy, what I do, has a huge role to play in ensuring quality and safe health care with respect to information management. Ideally, if I was a health care provider, I should be able to effectively push a button and summon the types of information I need to know about you as a patient.
However right now, what happens in the Canadian context is health care information is locked up silos. So, if I’m a health care provider and I see a patient presenting with abdominal pain, the absence of a longitudinal record can really impede my ability to make a good clinical judgment because I don’t have all the information I need. It’s effectively practicing medicine with one or both hands tied behind their back. How we get to system-wide interoperability to ensure the democratic exchange and movement of health information in the province to ensure quality and safe care for British Columbians keeps me up at night.
The digital divide also keeps me up at night. Before the introduction of digital health and virtual care, we already had equity issues in health care. It manifests in so many ways, such as digital literacy, health literacy. If you’re Indigenous, you may not be able to access the same kind of quality of care. Will virtual care further exacerbate the inequity issues that already exist in health care? Digital health services probably mitigates some issues, but also come with their own problems.
The third one that keeps me up at night is the question of cultural safety in health care. If we want to start addressing inequities in health care, if we want to start addressing why certain populations have different health outcomes, then I don’t think we can do that without really doing a serious rewrite of the health care system to ensure that cultural safety is embedded into it, and first and foremost for Indigenous peoples. We need to integrate culturally safe practices into a system that has historically harmed people.
SPPGA: Do you see progress on any of those fronts? Is there a lot of movement being made or is really at the beginning stages?
I think this government and the one before it has been very committed at the highest levels to the reconciliation process. But I think we’ve got a long road to go. I think there’s some deeply entrenched ways of thinking about things that go beyond the will of governments.
If you ask me, can we somehow legislate a policy to take the racist out of people? We can’t, they’re people. But we can create infrastructure and approaches to doing things that encourages the environments and service provision we want to see.
“I’m excited to come to UBC SPPGA because it’s the next generation of public policy makers – we’ve lit some fires but come make them bonfires!”
SPPGA: Your leadership on developing provincial standards, policies and guides for virtual care and digital health has played an important role in B.C.’s response to COVID-19. What have you learned through this experience in the pandemic and what would you have done differently, if anything?
The pandemic catapulted the policy work underway on virtual care to a great deal of relevancy. If you told me virtual care would become incredibly relevant to Canadians when we first started in 2018, I would have laughed. No one was doing this in Canada. It took a pandemic to shift the health sector in Canada towards doing virtual care; what will it take to sustain the changes in a manageable way?
I think one of the things that we could have done differently is to make our process more transparent for people that are outside of public policy and outside of the ministry. Our process of what we do with stakeholder feedback is not well understood, notwithstanding our best efforts. To an external observer, it may seem that we obtain feedback and then disappear, with no immediate public presentation of the policy when we are actually going through our own internal processes before a policy can be released. So next time when I’m doing sector wide policy, I’m going to look into having a public facing site set up where stakeholders can see progress – a project management tracker. I think, in terms of the feedback loop, when people are excited or have contributed to the work, they want to know what’s going to happen next. We can do this better.
SPPGA: Tell us more about your project proposal for virtual care. How is virtual care tied into equitable health care access in B.C.? What are the policy implications of virtual care? Is this work transferable to other jurisdictions?
My project proposal is a cohort study that will used a mixed-methods approach to assess the impact of virtual care and digital health on equitable access. I’m using a triangulation method that relies on three pillars. The first is, there is emerging evidence from other jurisdictions, notably in the United States and Australasia, on the impact of equity of access, so I’m going to do a literature review of the evidence.
The second pillar is qualitative. I’ve already been reaching out to the health sector on this. I want to do interviews with health care providers and patients on their perspective on what virtual care has done for equitable access. I want to try to reach some patients in a non-digital way if possible because of the digital divide.
The third pillar is the quantitative. We have a fee-for-service model of health care; we have billing data for the Medical Services Plan. In April 2020, virtual care took off in B.C. Prior to that, our data showed hardly any services delivered virtually.
I want to do a study for two distinct populations – an economically-stressed group (if you’re eligible for a government subsidized program) and compare at an aggregated, de-identified population level how they were accessing health care prior to the pandemic and how are they accessing care since virtual care took off. I want to do the same for Indigenous peoples.
That’s where it is right now and I’m excited about it. In talking to my colleagues across the sector, this hasn’t been done before in B.C., and probably not in the rest of Canada. If the model I develop is sound, then it will be transferable to other jurisdictions.
SPPGA: Practitioner Fellows engage with our community in three main areas: Student and Community Engagement; Research; and Teaching and Learning. What activities will be you be pursuing in each area? What are you most excited to engage in?
I’m excited about all of these areas! I’ve already started reaching out to explore opportunities for student-community engagement. I’m interested in hiring a clever summer Co-op student from the MPPGA to help with my virtual care research project. I’m also going to be looking for another student to help with data modeling, statistical analysis, and data analysis.
I have a long track record of recruiting Co-op students from universities to eventually become public servants with me so I view this as my ongoing campaign to build a network of future public policy makers for our province.
I’m also excited to learn from my peers; to learn what’s changed and explore novel approaches and trends in public policy.
I’m exploring the idea of teaching and leading a workshop or lecture that explores the idea of the relevance of public policy in the age of ongoing digital transformation. I’m also exploring the idea of leading a workshop on considerations for joining or working in the public service, notably for public policy.
I’m really delighted and honored to be given this appointment.
Thank you Natasha.
