The 2024 Symposium focuses on the significance of people-centered health systems that adapt to global changes while safeguarding our planet for future generations. Establishing equitable and sustainable health systems prioritizes individuals and environmental protection. Climate change affects both health and health systems. Robust health systems are crucial for attaining health equity, a primary objective of Health Systems Global and an integral part of the international Sustainable Development Goals (SDGs).

Sub-theme 1: Strengthening Health Systems for Planetary Health
This sub-theme emphasizes the need to build health systems research, policy, and programmatic momentum in critical areas:

• Strengthening climate-resilient health systems: Population health is tied to planetary health. Our health systems, historically focused on treating illness, need flexibility to tackle challenges like climate change, urbanization, biodiversity loss, and pandemics.

• Strengthening environmentally sustainable health systems: Health systems impact environmental change through resource use, waste, and energy consumption. The One Health approach highlights challenges from climate change, urbanization, biodiversity decline, and pandemics, stressing private sector involvement in sustainable healthcare and addressing climate-related factors.
• Policy creation and governance for climate-resilient systems: Enhancing health systems and policy research is crucial for developing sustainable policies. Investigating the political economy of health system adaptation, addressing financing shortfalls in low—and middle-income countries, and examining policy inconsistencies at local levels is vital. Health systems leaders play a crucial role in mitigating planetary damage.

Sub-theme 2: Advancing justice, inclusion, and belonging in health systems in times of peace and conflict

• The sub-theme highlights the need to address gaps in inclusivity and belonging, ensuring health systems alleviate social inequity. Centering on lived experiences, especially in conflict zones, individuals encounter various barriers to healthcare, including discrimination and limited resources. Research must capture the relational and quality aspects of these experiences to reform health systems. HSR2024 aims to discuss intersectionality and power in health policy. Barriers like knowledge silos hinder health system improvements aimed at justice and inclusion. Research on factors that enable quality service and justice in fragile health systems is needed. Recognizing equity-enhancing financing models, research on innovative approaches to health financing is vital for reducing discrimination and improving outcomes. Structural change is crucial, as racism and bigotry negatively impact health. Supporting structural reforms against racism and promoting transformative public health approaches are vital to dismantle systemic barriers. Sharing research and policies focused on strengths-based strategies is essential for developing respectful health systems.

Sub-theme 3: Health governance, policy, and institutional frameworks for Just and sustainable health Systems

Effective health governance, policy, and institutional frameworks should help create a shared understanding, facilitate coordination and collaboration, and encourage accountability. However, multiple gaps exist in our knowledge of how to define, design, and enact such institutions in the face of rapidly evolving technological, politico-economic, and epidemiologic imperatives. The sub-theme emphasizes the need for analytical and empirical work focused on the following areas.

• Governance and Institutional Frameworks for Health Systems: Effective health governance is essential for justice and sustainability. Policies in complex health systems often lack coherence. Strategies for policy development should encourage cross-sector collaboration and the market's role in health system enhancement. Emphasis lies on governmental impacts within mixed health systems, investigating private sector interests, and aligning them with sustainable health principles. Assessing the institutional landscape involves identifying gaps and proposing reforms. Research also delves into the structural causes of health workforce crises, examining how public policy affects worker migration, geopolitics, and global health diplomacy alongside innovative workforce management in remote areas and small island nations.
• Governance focused on bolstering public health tackles commercial and cultural factors, assessing national policies to retain skilled workers during pandemics. It requires integrated health information systems for decision-making and effective resource allocation. Advanced policies emphasize various surveillance methods addressing commercial health determinants. Governance must also boost community engagement and restore trust. Understanding the impact of power dynamics and political economy on health policy outcomes is crucial.
• Stewardship of digital transformations, including AI and big data, is vital. The WHO Global Strategy on Digital Health 2020-2025 identifies digital technologies as central to sustainable health systems and universal coverage. Concerns still need to be addressed regarding the efficacy of stewardship and oversight frameworks, especially regarding AI security and ethical use. Addressing both empirical and normative digital technology governance is critical for health systems and designing strategies to enhance health systems and population health. Evaluating necessary frameworks and regulatory infrastructure is essential to adapt to the changing IT landscape and assess whether participatory governance fosters social accountability and trust

Sub-theme 4: Knowledge for Just Health Systems

Epistemological, ethical, and methodological choices influence the production and use of knowledge for health policy and systems, reflecting the underlying values of researchers and practitioners. The sub-theme aims to extend and amplify conversations about these choices and stimulate debate and shared learning about approaches to producing and using knowledge better aligned with a just and sustainable health system.

• Addressing epistemic injustice in research and education: Hierarchies of knowledge shape health policy and systems, often excluding marginalized groups. It is vital to challenge and transform these injustices while considering intersectionality's role in knowledge creation. Analyzing Indigenous and diverse knowledge systems is also necessary, focusing on ethical frameworks and methodologies that disrupt power dynamics like data sovereignty and cultural governance. Examining curriculum design and counter-narratives is critical to promoting inclusivity.
• Identifying values: Values are foundational to health policy, guiding decision-making and reinforcing existing knowledge production methods. Analyzing the values influencing health system practices and their alignment with social justice and sustainability goals is essential.
• Effective dissemination: Engaging stakeholders in improving health systems requires translating complex scientific and socio-cultural knowledge. Transparent communication fosters trust by promoting a shared understanding of issues and evidence. Research into knowledge translation and open-access publishing models is encouraged to develop equitable health systems.