Day 4: Leadership as agency

Activity 8: Leadership as agency

2 hours 30 minutes


To help us to:

  • Discuss ways to view leadership as agency
  • Consider leadership approaches that build the capacity of people and organisations to act and effect change
  • Integrate our SSDOH learnings in deepening our own SCIs

Task 1
Group work: Exploring strategies for power through the David & Goliath story

1 hour 30 minutes

In your group, you have 1 hour to decide how to navigate your reading, either alone or together:

  1. First read the overview box below that frames and encourages our grappling about what leadership as agency involves
  2. Then read the familiar story of David and Goliath, captured in the cartoon book at this link:

You then have 30 minutes in your group, to engage each other on the following questions and be ready to present your group’s answers in plenary:

  1. How did David utilise his few war resources to defeat Goliath?
  2. What knowledge and skills did David need to fight Goliath?
  3. What was David’s overall strategy to defeat Goliath?
  4. Are there any lessons in the story for the kind of leadership to fight health inequities in our societies?

Task 2
Distilling the key features of leadership that strengthens agency

1 hour

In plenary, we will engage each of the questions for about 10 minutes on each, and then step back to draw out what we collectively get to as the most critical features of leadership that strengthens agency in our society. We will end with around 20 minutes, to loop back to our SCIs, and what this says for our approaches developed so far. 

Leadership as agency

In previous sessions, we discussed how factors such as income and wealth, status, gender and race, sexual orientation, learning opportunities, literacy levels, transportation networks, social infrastructure and physical environment shape the health status of individuals and communities. Access or lack of access to these services, shapes outcomes of health systems in different countries – life expectancy, infant mortality rates, maternal mortality rate, and prospects of disease and disability free life. 

In Module 2, we also discussed how organisation and movement-building are necessary to deal with differences in health status or in the distribution of health resources between different people, communities and groups. We looked at how throughout the world, to deal with these health inequities, different forms organisations were established – membership-based movements, networks, social entrepreneurial organisations and a range of non-governmental organisations (NGOs). The role of these organisations and movements demonstrated that although social determinants do structure outcomes and access to opportunities, people have the capacity to act and effect change. 

The ability of movements, organisations and people to act and trigger changes demonstrates the dynamic relationship between STRUCTURE and AGENCY. As discussed earlier, in how societies function, there are factors and phenomena that influence, determine and structure certain outcomes. Examples of these determinants maybe one’s position within the economy, access to resources and social status. The determining factors are known as STRUCTURE. 

In Module 2 we explored how people have the capacity to act and change the structural determinants that shape possible opportunities and access. The ability to act and change structural determinants is called AGENCY. 

In this section of the module, we look at LEADERSHIP. While organisation and movement-building are central for changing structural determinants of outcomes and opportunities, the quality of leadership of organisations and movements is a critical component. To effect social change, a certain type of leadership is required. 

There are two critical ingredients to this leadership if it is to deal with structural determinants of health inequities in any meaningful way:  

The first ingredient is a clarity and bravery to act beyond the comfort zone of easy pat answers and solutions – digging deeply into the 5 whys to get to root causes and support actions that address those. 

The second critical ingredient is a leadership that recognises that history shows starkly, that thorough-going social change is always driven by movements of people; so progressive leadership must strengthen the capacity of communities, membership, staff, etc to take considered and well-timed action. This is agency and is about an unwavering trust that only self-emancipatory and self-liberatory approaches to organising and activism can bring the long-term structural changes to shift the SSDoH.  

Agency leadership is not about leading from the front with bold and creative ideas for change. It is about being leaders who are confident enough to work shoulder-to-shoulder with others struggling to make sense and shift seemingly impossible obstacles, in co-accountable self-organising ways. It includes the kind of tactical considerations we see in the David & Goliath stories, because we know well that those in power will not easily relinquish that control over resources.  

Progressive leadership is about being confident to be unpopular, to remain principled, because the nature of power is deeply understood, and the root causes of problems are collectively understood, and action is coming from this sound base.