Introduction
Over the past decade, international institutions have granted profuse access to a new stakeholder group in global governance: youth. It was particularly the Sustainable Development Goals (SDG) ‘moment’ that triggered a hyper-institutionalisation of youth in global politics, as reflected in the mushrooming of youth-specific bodies, forums, and positions ever since the 2030 Agenda for Sustainable Development was negotiated. As a recognised category of actors, youth were last in line on the long journey towards presumably more democratic and pluralist global governance – and many young people have taken advantage of an unprecedented level of accessibility for organised interests and transnational societal mobilisation in international institutions.Footnote 1 At the same time, though, those representing youth have encountered a densely populated advocacy ‘market’ in which they compete for access and voice with a broad array of non-state actors.Footnote 2
In this article, we explore how the opening up towards ‘youth’ as a novel global constituency plays out in practice. What makes youth a specific category of stakeholder and potentially contested political agent? Who is representing youth, its interests and grievances, in global governance, and to what extent is ‘youth’ a meaningful identifier in the struggle for recognition as a global governor?Footnote 3 Building on a nascent research programme on youth in international relations (IR) scholarshipFootnote 4 as well as performative theories on political representation,Footnote 5 our article addresses these questions by studying the presence and absence of youth in global health institutions. The study of how political representation of youth works in practice, we argue, can illuminate what is at stake in including yet another distinct subject position in global governance. It allows us to portray international institutions as not only reflective of gendered or colonial orders but also permeated by orders of age, that is, historically grown and sedimented hierarchies based on notions of definable periods or stages in life (such as childhood, youth, adulthood, or old age). Such orders may be both reproduced and/or challenged through youth representation in global governance. They are deeply intertwined with claims to expertise and credible, authoritative knowledge, since stages in life are associated with different degrees of maturity, responsibility, skill, and experience – and youth is still broadly perceived as a stage on the journey leading to these qualities.
Our article puts forward a theoretical and analytical framework that aims to be responsive to ‘youth’ as an intricate actor category. This intricacy derives, in the first place, from the indeterminacy of the idea of youth. Youth as a condition has two distinct characteristics: it is liminal and transitory.Footnote 6 It is defined by fuzzy boundaries, as the line between childhood and youth, or youth and adulthood proper, is contested depending on time and space. Youth is essentially defined by its in-betweenness, by belonging to neither the realm of the child nor the world of the fully competent, autonomous adult. This in-betweenness makes youth comparable to other liminal subject positions in international relations whose identity can be characterised as ‘sitting on the fence’, such as stateless nations and indigenous peoples.Footnote 7 At the same time, youth as a category of age denotes transition – a journey from childhood to adulthood, which implies that those who speak, act, and decide as youth and for youth will, at some point, no longer belong to that category. Unlike other stakeholder groups in global governance whose recognition rests on the assumption of a stable identity (such as sexual identity or ethnicity), youth is a transient status. Youth is emblematic for the not yet: not yet grown up, not yet fully competent and expert, not yet fully developed political agent. Given this indeterminacy and liminality of youth, the study we present in this article was driven by the curiosity to know to what extent youth can, indeed, be a meaningful subject position from which to derive rightful claims to political representation in international institutions.
For our analytical framework, we borrow from performative theories on political representation.Footnote 8 These theories allow us to go beyond an understanding of representation as formal entitlement and physical presence, placing analytical value on representation as activity and articulation. To grapple with youth as a liminal and transitory subject position, we argue, performative representation theory is of both theoretical and analytical advantage. In the first place, approaching youth through the lens of representation rather than participation means to refrain from taking the label ‘youth’ at face value. Instead, understanding representation as performance draws attention to who, in participating in global governance in one way or another, is in fact putting forward a claim to represent, that is, to stand in for, (global) youth and/or its interests and grievances. While participation may refer to any kind of engagement, representation raises questions of entitlement, status, legitimacy, and leverage in policy-making processes. Secondly, performative representation theory abandons notions of a pre-formed ‘demos’ or ‘(imagined) constituency’ whose interests are represented. Instead, it focuses on how collectives are discursively constructed and, as such, brought about through the representative practices of those claiming to stand in for other people.
We extend performative representation theory by including absence and ambiguity as dimensions of representative performances. As a first extension, we conceptualise absence as an effect of limited or inexistent opportunities for articulating representative claims. While actors may enter the premises of international policy-making as representatives of ‘youth’, they may feel an acute chasm between their being physically present, on the one hand, and their inability to speak out and be heard where it matters, on the other hand. And secondly, we propose performative liminality as a useful analytical lens through which we can study how those accessing international institutions with the youth ‘ticket’ may explore and exploit the contested boundaries of youth. In doing so, they may seek to undermine or even subvert youth as the ‘not yet’ by espousing other subject positions in their interactions with non-youth (state and non-state) actors.
Empirically, we apply our theoretical propositions and analytical framework to youth representation to global health institutions. We have chosen global health as a suitable issue area for a number of reasons. The least significant among these is the fact that, to date, there has been no analysis of the contours and implications of youth representation in global health politics. The burgeoning literature on youth in global governance has been, unsurprisingly, spurred by empirical research on youth in global climate and environmental governance and, to a lesser extent, peace and conflict as well as migration studies. With our study, we thus expand the spectrum of youth research in IR and fill a theoretical and empirical void in the literature on (global) health policy-making. It is, however, for more profound reasons that a study of youth representation in global health is auspicious. First of all, global health institutions have undergone the developments that we described for global governance overall: a multiplication of international institutions and an opening up towards a growing set of stakeholders, including youth. Health IOs’ mindfulness towards youth has grown exponentially since the COVID-19 pandemic, routinely framed as having brought about a ‘lost generation’ of children and youth.Footnote 9 And yet, secondly, despite their increasing permeability towards non-state actors of all kinds, global health policy-making has been and continues to be predominantly shaped by biomedical experts. On the basis of these characteristics – opening up yet expert-driven – we expected global health to be characterised by a particularly acute chasm between access and voice.
We base our account on a qualitative analysis of primary documents from international organisations and youth-focused institutions and events, as well as twenty-nine semi-structured interviews with youth representatives and global health policymakers surrounding the World Health Summit (WHS) in October 2021 and October 2022 and the World Health Assembly (WHA) in May 2022. Our analysis brings to light a significant tension between a diversifying institutional landscape of youth participation in global health and the persistent contestation surrounding political agency of young people in a policy field that is routinely portrayed as apolitical as well as technology- and solution-driven.Footnote 10 In many ways, our study confirms that those representing youth confront multiple barriers towards representation that are similar to those of other organised interests. We also observe that the inclusion of youth as a stakeholder group feeds into legitimation practices of IOs that want to be seen as more inclusive, diverse, and responsive to the grievances of different societal groups. It is particularly hybrid global governance institutions, including public and private actors, but driven very much by corporate governance logics and philosophies, that aim to speak to and for youth. Taken together, our findings confirm that ‘youth’ as a subject position plays a constitutive role in defining the purpose and rationale of IOs and their private partners in global governance. Youth consolidates rather than challenges established orders of age. We also find that many youth representatives work within the limits of these orders of age based on hierarchies of age and expertise and willingly embrace neoliberal philosophies on youth leadership, innovation, and problem-solving. They do so particularly when seeking to gain access to high-level venues of international cooperation and diplomacy, accepting the label ‘youth’ and the images of youth that IOs disseminate.
In the next section, we develop our theoretical approach to youth representation in international politics through a critical appraisal of prominent constructivist and performative theories on representation. Thereafter, we present our empirical study. Following a contextualising introduction and a discussion of our methodological procedure, we proceed in three main steps. First, we discuss how prevalent IO narratives in global health represent youth as an imagined constituency. Secondly, we explore the multiple barriers and intersecting inequalities that condition institutional access and mark the site-specific enactment of youth representation. Finally, our empirical analysis brings attention to the reflexive and ambiguous ways in which youth representatives embrace, enact, and question ‘youth’ as political category as they navigate exclusive spaces of global health policy-making. The conclusion discusses the implications of our findings for the study of transnational political representation and political agency of marginalised populations in international institutions.
Theorising youth representation in IR: Presence, absence, and performative liminality
In recent years, a nascent scholarly community and debate on the impact and invisibility of youth in international politics has been forming, predominantly in the fields of peace and security,Footnote 11 environmental and climate politics,Footnote 12 and migration.Footnote 13 A main motif behind this research programme was the realisation that in IR scholarship children and youth were ‘seen and not heard – positioned and increasingly politicised, but not engaged with’.Footnote 14 A mounting body of empirical research has rendererd children and youth visible – as not only objects of concern in global governance but also as societal actors and political agents, inside and outside of international institutions. This research into youth as shapers and contesters of global governance resonated well with a broader theoretical interest in political representation of non-state actors in global governance.
In this article, we draw on performative theorising and contemporary conceptualisations of political representation as shaped by both presences and absences to study the import of youth in international politics. Performative representation theory, we want to argue, bears tremendous potential for addressing the rift between access and voice, the liminal quality of youth, and the struggles and ambiguities surrounding representative power of groups with contested political agency. Approaching youth through the lens of representation rather than participation means to refrain from taking the label ‘youth’ at face value. In the next section, we mobilise performative understandings of representation that place analytical value on representation as activity and articulation, rather than formal entitlement and physical presence. We also extend these theories by including absence and ambiguity as dimensions of representative performance and by elaborating on the specificity of ‘youth’ as a liminal and transitory actor category.
Political representation as performative claim-making
Following Hannah Pitkin’s canonical theory, political representation is the activity of making citizens’ voices, opinions, and perspectives present in public policy-making processes.Footnote 15 In practice, political representation occurs when ‘political actors speak, advocate, symbolize, and act on the behalf of others in the political arena’.Footnote 16 For considerable time, political theories on representation have been excessively focusing on questions of the institutional design (access, rules of interaction, voting rules) of institutions attributed to the (democratic) political system, with the state being the primary point of reference. In contrast to such formal understandings, political theorist Michael Saward invites us to understand representation as a dynamic process of claim-making on behalf of an imagined constituency, and thus to move ‘away from the idea that representation is first and foremost a given, factual product of elections, rather than a precarious and curious sort of claim about a dynamic relationship’.Footnote 17 Viewed in this way, representation does not refer primarily to formal institutional arrangements but ought to be conceived as an unstable, continuous performance.
Performative understandings therefore abandon notions of a pre-formed ‘demos’ or ‘(political) constituency’ and instead focus on how collectives are brought about. In her work on cultural self-representation and the (im)possibility of subaltern voice, Gayatri Chakravorty Spivak distinguished between Vertretung as the act of ‘stepping in someone’s place […] to tread in someone’s shoes’ and Darstellung as ‘placing there’.Footnote 18 Representation therefore has two sides – it is both ‘proxy and portrait’ of a constituency.Footnote 19 Spivak also reminds us of the difficulties at play in any attempt to locate political agency, the voice of subaltern or marginalised subjects, fully beyond representation. As she puts it,
it is not a solution, the idea of the disenfranchised speaking for themselves, or the radical critics speaking for them; this question of representation, self-representation, representing others, is a problem.Footnote 20
In other words, speakers never simply speak for specific interests and positions; they also construct their own position by giving a picture of the constituency that they claim to represent. In this sense, ‘speaking for’ and ‘portraying’ inevitably intertwine.
It follows from this that those actors who are positioned to put forward ‘representative claims’ can at the same time make use of their power to define both the interests and the very identity of the collectives that they aspire to speak for.Footnote 21 Representative acts of speaking for others thus come with the inherent danger of misrepresenting their views and experiences by universalising one’s own social location.
Yet as feminist political theorist Linda Alcoff reminds us, not speaking or representing is also not a solution: the choice not to use the opportunity to speak against injustice in order to escape responsibility for one’s potential (mis)representations of others is also a political act with material consequence. Rather than speaking in an untroubled, unreflective way about others or refraining from dangerous speech, the effects of representative speech acts matter: ‘one must look at where the speech goes and what it does’.Footnote 22
Political representation as presence and absence
While the dynamic, performative conceptualisation of representation put forward by Saward allows capturing different aspects of representation as a delicate process of discursive negotiation, it has its limitations. To begin with, there is an over-emphasis on the marketplace of representation, in which those representative claims we deem important in policy-making processes are simply those put forward by actors that are loudest and most resourceful. With Spivak and Alcoff, the study of representation must instead be reflective of structurally inferior positions of potential speakers that result from unequal economic starting conditions, language barriers, or systematic discrimination.Footnote 23 It thus becomes ethically relevant to ask how it is that specific groups and individuals – rather than others – become institutionally, materially, and discursively positioned to speak for/of (women/minorities/youth etc.) in universalising terms, and how such inequalities complicate the play of representations. We consider this question to be of both analytical and political importance in the analysis of youth representation in global politics. Intersectional and black feminist scholarship has illustrated in great depth how ‘women’ and their experiences are united through experiences of unequal gender relations, yet at the same time are also divided by race, class, culture, and other social fractures.Footnote 24 So, we argue, are youth. Indeed, paying attention to both commonalities and differences in the social positionality and possibility for political articulation among youth seems particularly warranted in global health as a transnational policy field marked by depoliticisation and hierarchical knowledge politics that privilege biomedical expertise.Footnote 25 In our analysis, we therefore explore who – amongst the vast global constituency of young people – becomes positioned to speak for and portray ‘youth’ international institutions – and how.
To this end, our theoretical framework builds on newer approaches to political representation that introduce absence and silence as vital analytical dimensions in the study of political institutions.Footnote 26 At the heart of these approaches lies the proposition that, even in cases where formerly excluded participants in a political debate find access to relevant institutions and settings, they may be confronting the very same ‘discursive power dynamics whereby they were silenced in the first instance’.Footnote 27 Hence, absence and presence (both physically and performatively) must be given equal room in the assessment of political representation with several aims in mind: first, to put the hypothesis to test that more presence is the ‘proper response to injustice’;Footnote 28 and, secondly, to observe ‘how power dynamics within representative contexts can render presence ineffective’.Footnote 29
In our empirical study of youth representation in global health, we mobilise these notions in two regards: first, we turn attention to the multiple intertwining barriers to participation that, in practice, condition who gets to stand in the place of youth in international institutions (and who does not, i.e., who is absent). Second, we find that physical presence does not translate easily into opportunities for articulating representative claims. While our interviewees often entered salient sites of policy-making as representatives of ‘youth’, their practical experiences of these spaces expose a chasm between their physical presence on the one hand and their inability to speak out and be heard in a politically consequential manner on the other. In this way, absence also manifests as an effect of limited or inexistent opportunities for political agency and articulation.
Performative liminality and the ambiguities of youth representation
This leads us to what we regard as a second limitation in agency-oriented, dynamic, and performative conceptualisations of representation: they rest on a simple picture of ‘representative claims’Footnote 30 as readily identifiable: an ontologically given genre of political speech. For empirical research, this suggests that social performances are either about representation or not about representation. Yet, there are several aspects in our empirics that complicate this simplistic understanding of representation as an either/or. First, the notion of ‘youth representation’, together with related terms such as ‘youth engagement’ and ‘youth inclusion’, also serves as a legitimation narrative for international institutions. Second, IO discourse and legitimation narratives on ‘youth’ create an institutional and discursive entry-point for young people to speak in invited spaces that are, generally, very exclusive and populated by adult professionals/experts. Yet, the way in which young people make use of this position is much more ambivalent and ambiguous than is assumed by the literature.
Some young people we spoke to about their participation in key sites of global health policy-making did advance claims about the experiences and grievances of youth as a constituency. Yet at the same time, they also reflexively questioned the fuzziness of ‘youth’ as a collective identity; they emphasised the diversity of lived experiences among youth and the intersectional overlaps with other identities and experiences that relate to gender, class, ethnicity, citizenship, and North–South relations. Moreover, our interviewees embraced the position of ‘youth’ to varying degrees. They often aspired to be perceived as health and/or policy experts – either instead of, or in addition to, being perceived as someone speaking by virtue of their young age (as a ‘youth representative’, ‘youth advocate’, ‘young entrepreneur’, ‘next generation leader’, and so forth). In other words, some of our interviewees sought to make use of youth as a discursive and institutional entry-point for participation in exclusive, ‘invited spaces’Footnote 31 of policy-making in order to pursue career-building and networking opportunities. In practice, performances of ‘youth’ representation, professionalisation, and socialisation into the world of international (health) diplomacy therefore overlap and intertwine.
Youth is a liminal and transitory actor category. It is marked by a constitutive in-betweenness, a state of belonging to neither childhood nor adulthood proper, as defined, for example, on the basis of a certain threshold age, of levels of competence/expertise or responsibility. In global governance, youth representatives thus figure as not-yet fully competent actors in a way that limits representational presence in the stronger sense of being able to articulate propositions that are heard and validated by others. Among those young people, often aspiring health professionals, we spoke to, who had accessed international institutions through ‘youth’ as an institutional and discursive entry-point, it was therefore not uncommon to subvert and problematise ‘youth’ by espousing other (adult) subject positions – such as being representative of a certain geographical region, gender identity, or area of biomedical expertise. We call this ambiguous practice of both invoking and revoking, embracing and problematising ‘youth’ as a constituency performative liminality. As an aged, liminal, and transitory identity category, representing ‘youth’ thus involves specificities and ambiguities that set it apart from representative claims and practices advanced in the name of other, more well-studied constituencies in global governance.
The analytical framework that results from our theoretical assumptions thus builds on representation as performative but ambiguous practice that brings about and rests upon both presences and absences. In the next section, we use this framework to throw light on youth representation as it plays out in practice in global health governance.
Presences and absences of young people’s political representation in global health
Institutionalised participation of young people in global health institutions has a decades-long historyFootnote 32, marked by strong institutionalised ties between biomedical students’ associations and the WHO. The International Federation of Medical Students’ Associations (IFMSA) has enjoyed the status of being ‘in official relations with the WHO’ since the late 1960s.Footnote 33 Still today, the IFMSA and the International Pharmaceutical Students’ Federation (IPSF) are the only two youth organisations with this status, which allows for civil society organisations to deliver statements during the official proceedings of the World Health Assembly (WHA) and WHO regional meetings.Footnote 34 This privileged position of biomedical student associations in representing ‘youth’ sets global health apart from other global policy fields, such as environmental governance or migration, where youth have been found to constitute a more activist constituencyFootnote 35 and where specialised expertise acquired through years of academic training may thus be less significant as a factor in determining who gets to speak in the name of youth (and who does not).
Despite these notable historical continuities, the landscape of youth engagement has also changed, expanded, and diversified in remarkable ways over the past decades. During the time we conducted research for this article, the World Health Organization established a new WHO Youth Council whose purpose is, among other things, to prioritise an inclusive WHO Youth Engagement Strategy.Footnote 36 While this stands out as particularly noteworthy initiative towards institutionalising youth representation, it is embedded in a wide variety of recent institution-building exercises meant to carve out a space for youth issues and voices in global health and beyond.Footnote 37 On a normative level, procedural norms on the rights of children and young people to be heard as established in Art. 12 of the UN Convention on the Rights of the Child have been firmly enacted across the UN system and other international institutions since the early 1990s. ‘Children and youth’ are recognised as a ‘major group’ of stakeholders in the 2030 Agenda for Sustainable Development and UN Youth that has been created as a coordinating body for youth engagement at the United Nations.Footnote 38 In global health and development, there is a broad rhetorical consensus among IOs, NGOs, and private actors about the normative desirability of meaningful youth engagement.Footnote 39
Moreover, in recent years, contemporary youth engagement in global health has become marked by an expanding range of hybrid public–private collaborations. For instance, a Young Health Programme was initiated by AstraZeneca in 2010. In collaboration with UNICEF, Plan International, and over thirty other public and private ‘expert organisations around the world’, the programme focuses on young people in vulnerable environments and seeks to ‘develop young leaders’ and strengthen ‘the voice of youth’.Footnote 40 The Lancet and Financial Times Commission on Governing Health Futures 2030 provides for another illustrative example. It was founded by the Children’s Investment Fund Foundation, Fondation Botnar, the Wellcome Trust,Footnote 41 and the Global Youth Mobilization – itself a partnership that includes the WHO and the WHO Youth Council, the UN Foundation, six large youth organisations,Footnote 42 the International Federation of the Red Cross, and the Duke of Edinburgh.Footnote 43 The actual practice of youth representation in global health, thus, happens through a variety of organisations, groups, and individuals advance that claim to represent young people; that speak to a broad set of health-specific issues; and that are embedded in widely ramified networks between IOs, youth organisations, (I)NGOs, public–private partnerships, powerful companies, and philanthropies.
Studying youth representation in practices: Notes on methodology
Among the many areas in which public and private actors collaborate on youth representation, global health thus stands out as an especially lively terrain. Our article takes this observation as a starting point to throw light on the politics of youth representation. Health is a suitable issue area to study youth representation in global governance for a number of reasons. In the first place, it adds empirical nuance to the burgeoning IR literature on youth, which has so far focused on environmental governance, peace, and security. Secondly, global health governance is symptomatic for larger historical trends in international institutions: it is a crowded, pluralised institutional field that has opened up towards a large array of new IOs, partnerships, and private and civil society actors, including youth.Footnote 44 At the same time, it is also an expert-driven and epistemically hierarchical field, where biomedical knowledge outstrips other epistemic repertoires.Footnote 45 This makes it a fruitful case for grappling with the troubles of representation that we discussed earlier and to explore how, in practice, international institutions’ will to pluralise the voices they listen to and open up their processes is hurt by the harsh reality of their functioning.
We used two concrete empirical research strategies: interpretative analysis of policy documents and semi-structured narrative interviews. First, we sought to identify dominant narratives on youth participation by analysing policy documents and webpages published by IOs and youth-focused partnerships. Relevant policy documents and online statements were identified through a systematic review of youth-related initiatives and institutional entities in global health IOs, international events and summits, hybrid partnerships, and platforms across global health. Here, we combined desk research and snowball techniques with information from our qualitative interviews and our participation in three major global health events in 2021 and 2022. Our interpretative reading of the resulting text corpus focused on identifying recurrent portraits of youth as a constituency along with narratives about their rights, interests, and appropriate role in global health. Rather than proceeding from any notion of youth as a pre-formed constituency (defined, for instance, by a given biological age range), our analysis explores how ‘youth’ is discursively constructed by both youth and adult proxies in global health.
Secondly, we conducted twenty-nine interviews with young people who participated in three major global health events: the 75th World Health Assembly (WHA) in Geneva 2022 and the World Health Summit (WHS) in Berlin 2021 and 2022. Our choice to study these two venues was informed as much by their perceived importance in policy circles as by their internal differences. The WHS and the WHA reflect the historical evolution from international to global healthFootnote 46 to the extent that they epitomise different types of global health institutions. While the WHA stands unrivalled as the world’s primary forum for formal state-driven health diplomacy, the WHS is a prominent example of how global health has developed towards informal, privatised, and fragmented global governance by hybrid networks. Constraints for civil society actors are strong in both settings, reflecting the situation in global health at large. Conducting interviews during the WHS and the WHA thus allowed us to draw more general inferences and provide a more nuanced analysis of youth representation in global health today. We chose these sites as they are seen as the two most important global health forums, whilst at the same time being qualitatively different. This qualitative variation allows us to reveal broader patterns of youth representation in global health that hold true across different kinds of forums and institutions that mark the field.
Our interviewees were all legal adults, either students or young professionals, and most of them between the ages of 20 and 35. The majority of our interviewees were originally from Europe and North America. It follows logically from our theoretical framework that our interviewees were identified because they were attributed the label ‘youth’ in the official programmes of WHA and WHS – not on the basis of biological age. Following Saward’s account of representation as a dynamic and precarious act, we regard youth as a constituency that is brought about in representative practices (not as a pre-formed, given age group; see pp. 10, 21). In designing and analysing our interviews, we sought to identify barriers and opportunities that youth experience in these exclusive and pertinent ‘invited spaces’Footnote 47 of global health governance policy-making and to throw light on absences and ambiguities in their representative performances. Accordingly, interviews focused on interviewees’ experiences of intersecting inequalities that condition who gets to speak in the name of youth in global health. We also sought to learn about interviewees’ understandings of ‘youth’ as a constituency and the extent to which they embraced ‘youth’ as an identity marker. We were thus interested in exploring, who – amongst the many millions of young people on the planet – becomes positioned to speak of and for youth in global health institutions, and in understanding the extent to which physical presence translates into a space for effective political articulation.
Vulnerable group, innovative entrepreneurs, or future leaders? The absence of political agency in dominant narratives on youth in global health
Contemporary global health discourse is ripe with statements on the importance of including young people’s voices. For IOs, hybrid partnerships, and private actors who engage in and seek to shape global health policy, ‘youth engagement’ has become an important legitimation narrative as they seek to present themselves as inclusive, diverse, and responsive to the grievances of different societal groups. As the first official press release on the establishment of a WHO Youth Council explained, ‘WHO is keenly aware how vital it is to listen to young people and learn from them’.Footnote 48 Commenting on the virtual Global Youth Summit that his organisation and the Global Youth Mobilization jointly organised in April 2021, WHO Secretary-General Dr Tedros Adhanom Ghebreyesus similarly emphasised that the ‘WHO [was] proud to support the global movement to engage and empower young people’ and ‘encourage[d] others to partner with the Big 6 and invest in the health and well-being of future generations’.Footnote 49 Indeed, support for the principle of youth participation and engagement extends well beyond the WHO: In 2020, the Partnership for Maternal Newborn and Child Health led the process of developing a Global Consensus Statement on Meaningful Adolescence and Youth Engagement. Just one year later, the statement had been signed by 249 IOs and NGOs from the health and development sector.Footnote 50
Despite the myriad initiatives spurred by this seemingly omnipresent embrace of ‘meaningful youth engagement’,Footnote 51 a closer look at the language through which youth is understood reveals a much more streamlined, less diverse landscape. With the exception of some more politically vocal youth-led organisations (such as the European Youth Forum, or African Young Leaders for Global Health), discourse on youth in global health abounds with harmonious narratives of common global problems to be solved through innovative and technical solutions, such as ‘translating evidence to effective policy advocacy’Footnote 52 or making a contribution to community outreach programmes and voluntary service.Footnote 53 Mentions of youth ‘interests’, ‘opinions’, or ‘positions’ are scarce. Instead, much emphasis is placed on how youth can ‘become part of the solution’ to global problems.Footnote 54 This is particularly noteworthy in the context of pandemic response, where both adult- and youth-led organisations stressed how young people ‘volunteer[ed] around the clock’Footnote 55 and used their ‘creativity and dedication [in] helping develop solutions to make sure communities emerge from the pandemic stronger than before’.Footnote 56 At the same time, youth is also seen as a particularly vulnerable group, with special health needs and experiences that merit protection. For instance, the Global Youth Mobilization stressed that the pandemic had:
disproportionately affected millions of children and young people worldwide, with public health restrictions and socio-economic disruptions having a devastating impact on their education, mental health, career prospects, safety and personal development.Footnote 57
However, the near consensual emphasis on the manifold ways in which global health policies affect young people rarely translates into articulations of political disagreement or opposition to the status quo of global health politics. Indeed, if one asks, with Spivak, what portraits of youth structure their discursive representation in global health, images of political conflict, activism, or resistance largely absent.
Instead, narratives on the role of young people in global health oscillate between portrayals of youth as a vulnerable group (‘lost generation’, ‘generation disrupted’) and an emphasis of their role as future leaders, experts, and innovators. Rather than political subjects with interests and opinions in the here and now, young participants and representatives are portrayed as future leaders, policymakers, and innovators, eager to contribute to unspecified lofty goals, such as ‘advancing global health’ and ‘positive, transformative change’.Footnote 58 To illustrate, a youth participation workshop at the Gates Institute was directed at young people ‘who exhibit exceptional promise and potential for leadership and achievement in global health’ and aimed to equip them with ‘new leadership, advocacy and communication skills’ so that they may ‘address complex challenges and maximize opportunities’.Footnote 59 In similar statements by youth-led organisations, youth were portrayed as the ‘backbone of the future and the new leaders of tomorrow’ who ‘offer refreshing and innovative ideas’.Footnote 60
These observations parallel earlier work on neoliberal ideology and how it ‘absorbs’ youth empowerment.Footnote 61 They also bring to mind critical work on neoliberal development discourse that underlines how conflicts are rendered invisible in depoliticised ‘win–win’ rhetoric that assumes that ‘everybody’ stands to profit from development cooperation.Footnote 62 In the dynamically unfolding world of youth representation in global health and (post-)pandemic politics, explicit mentions of intergenerational conflicts, potential conflicts within ‘global youth’ (gender, global south/north, different age groups, class, etc.), or the general idea that youth interests may be incompatible with (some aspects) of the current political and economic order (i.e., when it comes to the intersection of economic and health inequality) are similarly rare. Instead, the language of ‘problems and solutions’ contrasts current vulnerabilities of young people with their contributions to health and social well-being, whilst placing their political agency in the future. How do youth representatives and young professionals make sense of, navigate, or challenge the narratives on youth in global health that we identified in the previous section? What portraits of youth do they advance, and how do they view, embrace, or problematise their own role as potential proxies who speak for youth as a larger constituency?
Intersecting inequalities and the intricate enactment of representation: Who speaks?
Besides attending to discursive dynamics and how they constitute imagined constituencies, we have argued in this article that the study of political representation needs to take seriously absence and ambiguity as dimensions of representative performances. In practice, multiple inequalities among potential speakers inform their experiences and affect who gets to speak in the name of a given collective in the first place (i.e., who is made present).Footnote 63 In this regard, our interviews with young people who participated in the WHA and the WHS exposed a dense web of intertwining material, institutional, epistemic, and legal inequalities among youth that conditioned who gains access to these exclusive adult sites of policy-making. Moreover, our interviewees also elaborated on distinct types of knowledge, skills, and resources that they felt facilitated successful, competent participation.
A recurring theme in our interviews was the financial barriers that young people encountered when seeking to participate in global health events. This included the costs they incurred for travel, accommodation, participation fees, and – for youth from non-Western countries – visa applications. Official youth delegates to the WHA, elected IFMSA and IPSF officials, and young professionals attending on behalf of NGOs reported that they received travel grants, and participants in the WHS sometimes received free tickets through personal networks.Footnote 64 But most interviewees paid what they perceived as substantial economic costs out of their own pocket to finance their attendance.Footnote 65 These costs increased with travelling distance to Berlin and Geneva, unequal exchange rates between the Swiss Franc or the Euro and the currencies of attendees’ home countries, and lacking organisations affiliation.Footnote 66 As one interviewee who had their attendance at the WHA supported by a health INGO put it:
Geneva is one of the most expensive cities in the world for anyone, but especially like for youth from lower and low middle income countries, it is almost unachievable. So if it wasn’t for [health NGO] grant, we would never be able to attend.Footnote 67
Another interviewee from a South-Asian country who said they did not receive financial support for their participation in the WHA referred to it as a ‘very big investment’.Footnote 68 Being able to step in the place of and espouse representative claims on behalf of ‘youth’ as a global constituency thus hinges in a very fundamental way on unequally distributed material resources determined by interviewees’ social background and geographical origins.
Next to such blunt material realities, institutional characteristics, rules, and procedures also played a prominent role in our interviewees’ reflections on the barriers they had to overcome in order to participate in the WHS and WHA respectively. Besides the small number of official youth delegates who participate in the WHA as part of their member state delegation, youth involvement with the official WHA proceeding is limited to the IFMSA and IPSF, as the two only youth organisations with official relations with the WHO. As one interviewee put it:
only the medical students and the pharmacy students have access to Palais de Nations,Footnote 69 have an official relationship with the WHO, but the rest of the organizations don’t have this kind of privilege. (…) So yeah, I think this is the big, one of the biggest problems.Footnote 70
Representatives of both IFMSA and IPSF also described how they sometimes struggled with planning their delegation’s engagement during the WHA due to last minute organisational changes and cuts to the size of their delegation, and they emphasised the importance of transmitting knowledge of the formal and informal rules that mark the WHA as an institutional setting within their organisation through preparatory workshops and training (such as the IFMSA Youth Pre-WHA). In comparison with IFMSA and IPSF, though, the struggle of other youth representatives to participate and overcome institutional barriers at WHA is invariably more difficult. In fact, they must either liaise with the two official WHO-youth partners in order to voice their positions vis-à-vis the official statements of IFMSA and IPSF, or their representation is limited to the attendance of the numerous side events surrounding the WHA. IFMSA and IPSF therefore stand out as gatekeepers in the global health youth arena. For youth participating in the WHS, personal networks were perceived as important to gain access, and to seize networking and advocacy opportunities. These included invitations to informal side events, opportunities to speak on panels, and access to free or subsidised student tickets. Due to the relatively high prices of WHS ticketsFootnote 71 and the limited number of subsidised tickets for students and youth, one interviewee concluded ‘in terms of tickets, we have a problem’.Footnote 72
Academic backgrounds, expertise, and language skills also shaped the experiences that our interviewees spoke about. Previous research has documented the unequal recognition and stark hierarchies that exist between different kinds of knowledges in global health. This includes, before all, the privileging of biomedical knowledge over other subdisciplines of the medical sciences, and the poor recognition of non-medical and/or non-Western approaches to health and well-being.Footnote 73 It therefore comes as little surprise that all youth we spoke to were either enrolled in or had enjoyed formal higher education. A large majority had a biomedical educational background, and this was generally perceived as a valuable resource for both access and (successful) engagement with older, more established experts and policymakers. English language skills were also stressed as a crucial personal resource that was relevant to delivering statements, participating in panels, and networking with more senior professionals, and hence as a latent source of exclusion of young people from non–English-speaking countries and regions.Footnote 74 More subtle tactile abilities to enact and confirm the habitus of global summit participation through dress codes, UN and global health jargon and acronyms, and rhetorical skill also marked our interviewees’ stories about how they sought to navigate the WHA and WHS.Footnote 75 An interviewee who worked for an international network of global health activists and NGOs commented on how these performative dimensions intertwine with class and financial barriers. Young people participating in the WHA and similar events, they argued, were usually from ‘a certain class’. They elaborated:
You know, you’re English speaking, you’re very polished, you are able to kind of come from a certain class. […] So that’s something we need to really address.Footnote 76
Finally, differentiations and regulations related to citizenship and visas impeded access by young people from low- and middle-income countries of the global south. Visa application processes for travelling to Switzerland and Germany were described as both lengthy and costly, severely hindering the ability of those affected to plan their attendance. Accepted participants in both events were also denied visas and forced to cancel their participation or switch to digital participation as a result.Footnote 77 Again, interviewees’ reflections on the practical enactments of youth participation illuminated how different in- and exclusions intertwine and reinforce each other in practice:
one of my coordinators who was supposed to come to the WHO with me, she was denied because she cannot get the Schengen visa, she’s from Algeria. And another issue is that people from the Global South, in addition to like visa denials, like Switzerland is a very expensive country for them. So financial wise, it is really hard for them to go.Footnote 78
Viewed through the theoretical lens on youth representation that we develop above, this dense web of in- and exclusions has a twofold effect: it disciplines the forms of and limit the space for youth representation and it conditions who gets to speak in the name of youth in global health (and who does not). Here, broad social categories such as class, race/citizenship, and authoritative knowledge intersect with and operate through mundane institutional rules, personal networks, educational biographies, language proficiencies, and high travelling expenses in producing both presences and (involuntary) absences.
The liminal, transitory nature of ‘youth’ and the ambiguities of representational practices
Our interviewees’ accounts of their experiences also brought to light the reflexive and ambiguous ways in which they engage with and embrace, but also question and qualify, ‘youth’ as a category when navigating these exclusive spaces of global health making. Many interviewees expressed a strong sense of shared grievances and political preferences among young people. Younger generations, they told us, were to be more affected by the impact of climate change on human and planetary health, they cared more about advancing sexual and reproductive rights, health equity, and sustainable health systems, and they stressed the importance of mental health and the disproportionate effect of pandemic response policies on young people.Footnote 79
However, our interviews suggest that even though youth actors would have had to say plenty on these issues, they were barely invited to speak on thematic issues or give informed opinions on these matters. Statements on these issues supported claims for more meaningful youth representation, and they intertwined with portraits of youth as progressive, professional health advocates and a liberal and idealistic constituency. At the same time, some of our interviews strongly echoed narratives of youth as future leaders that we discussed above. For instance, one person told us that young people ‘have like this innovative spirit and […] will be eventually the leaders of tomorrow’.Footnote 80
Beyond these portraits of youth as progressive change makers and/or future leaders, our interviewees’ stories and reflections also gave expression to the performative ambiguous constitution of collective identities, and the liminal and transitory nature of youth as an identity description. To some interviewees, youth signified an early career stage.Footnote 81 For others it meant still being enrolled in education or being ‘part a nonprofessional setting’.Footnote 82 Still others attempted to define youth by biological age, with concrete proposals varying from below 25 to below 40, or even 50, years of age.Footnote 83 Moreover, some of our interviewees also explicitly elaborated on the difficulties of defining ‘youth’ in global health, stressing that ‘people are struggling to agree on a range of ages’ and that such a definition was ‘very, very subjective’.Footnote 84
A recurring theme in our interviews was the diversity of lived experiences among young people and the many ways in which ‘youth’ intersects with other identities. Several interviewees explicitly and reflexively problematised how the barriers to access that we analyse above affected young people differently depending on their overall social position, thus attesting to how age intertwines with class and education, gender, race/citizenship, and North–South inequalities. As a result, our interviewees expressed varying willingness to see themselves as speakers for ‘youth’ in general terms. Some actively embraced this position as a proxy and emphasised that while young people had different experiences, there was more that united them.Footnote 85 Others instead expressed discomfort at the idea of speaking for youth in universal terms. As an example, one interviewee told us that:
I would say I’m not representing […] the voice of youth, I think very few people can say that about themselves. I would be very critical of most people who say that they are representing youth in general.Footnote 86
Among those interviewees who problematised the notion of youth as a global constituency, some felt more at ease with the thought of representing a more specific group, such as young people from a specific country or geographical region, and/or with a specific ethnicity, gender, or a (usually medical) academic background.Footnote 87 Others instead described their own role as representing a given organisation or country delegation, hence tying their mandate to institutional rules for electing representatives and defining political priorities. An IFMSA representative we spoke to elaborated on these themes as follows:
Youth in general, it’s a general term that can include a big variety of people that have different backgrounds. Like for example, we are medical students. […] And that’s why, when I said, I can’t really say that I’m representing youth is, because I know for certain, I’m representing at least the federation IFMSA, because we have policies that are voted on by all our national member organizations that state our stances on specific matters.Footnote 88
Finally, interviewees’ self-identification with ‘youth’ as a category was rarely unambiguous. Rather, our interviewees exploited the contested boundaries of youth by undermining or even subverting youth as the ‘not yet’, instead espousing other overlapping and adjacent subject positions. Some self-identified based on gender, inter alia viewing themselves as speaking for (young) women, while others highlighted their geographical origins (for example, being from a low- or middle-income country). Several interviewees also gave expression to the sentiment that they were, in fact, aspiring/young health professionals or policy experts.Footnote 89 Here, the liminal and transitory nature of youth as an identity marker becomes practically important in interviewees’ performances. To provide just one example out of many, one person responded to the question whether they saw themselves as a young person by stating:
I mean, honestly […] I obviously I came into the space when I was like, a couple of years younger. And right now I feel like I shouldn’t be like, just youth anymore. […] I’m like, I’m a medical doctor. I’m an infectious disease researcher, I have like a master’s in public health. And like, I’m still considered youth, which sometimes I find a bit funny.Footnote 90
In this context, catering to ‘youth’ as a label and youth engagement as an established discourse with substantial traction in the policy field was perceived as an entry-point: a way to gain access to and the possibility to engage with otherwise exclusive settings of global health policy-making. When we asked interviewees about their motivations for participating in the WHA or WHS, almost all interviewees mentioned more strategic motives related to their own professional development, such as networking, and acquisition of skills and experience, besides more abstract normative ambitions of advocating for meaningful youth engagement or seeking to represent young people as an imagined constituency. Several interviewees spoke about what they described as rather frustrating experiences, where they felt reduced to being ‘the young person at the table’, rather than being taken seriously as a young(er) person with relevant expertise. There appears, thus, to be a considerable friction between mere physical presence of youth as mute bodies meant to represent and render visible the ostensible pluralisation of global health institutions, and the limited or inexistent opportunities for articulating representative claims that actors categorised as ‘youth’ are granted in practice, once they are inside global health institutions.
In practice, youth representation in global health is therefore much more ambiguous and multifaceted a phenomenon than the seminal constructivist theories of representation that we draw upon above would suggest. Many young people who engage in global health policy-making care deeply about shared grievances among younger generations and other policy issues that they view as vital to building a greener and more suitable, fair, and equal global health future. Yet at the same time, youth is an intricate identity marker. As a global constituency, youth is divided by myriad different experiences and socio-material positions of people who might be viewed as ‘young’. Due to its transitory and liminal nature, ‘youth’ invites ambiguous and reflexive performances that problematise the floating boundaries towards other social, political, and professional identities. Youth representation in global health is thus not clearly distinct from, but rather muddled and imbricated with, other social practices. Notably, it insects with career-building strategies employed by young professionals who embrace youth as an institutional and discursive entry-point, whilst also feeding into powerful global public and private health organisations’ legitimation narratives about their own inclusivity.
Conclusion
I’m speaking for myself. I feel like it’s always a lot to ask somebody like, who you speaking for. I mean, I understood the question, right? But I feel it’s also a lot of pressure. (…), if I look at demographics maybe at least, I go there with the intention to present underserved communities and – I don’t wanna say to represent – but maybe to voice what I think is important for communities that are not able to be at that stage, right?Footnote 91
When it comes to youth, international organisations (including global health IOs) are currently undergoing a hyper-institutionalisation. This phenomenon is accompanied – and in many cases justified – by statistical superlatives meant to underline the relevance of the many special programmes, initiatives, and campaigns for youth that have emerged in the past decade. In fact, the #Adolescents2030 campaign by the Partnership for Maternal and Child Health puts forward very strong claims to be representing the grievances and interests of 1.8 billion adolescents and young people in the world, whose health and well-being is presented as jeopardised and not sufficiently prioritised.Footnote 92 Our article has taken this diagnosis of ever-accelerating institutionalisation of youth matters as a starting point to explore how the opening up of international institutions towards youth plays out in practice. Exploring this question empirically, our intention was explicitly not to show whether youth does (or doesn’t) matter in global health policy-making and debate – but to make a contribution to the study of representation in international politics. Extending on the burgeoning literature on youth in IR, we studied the representation of youth in global health institutions through attention to both presences and absences, and we elaborated on the intricate, ambiguous nature of youth as a liminal, transitory subject position and global constituency.
Thereby, we have sought to show that engaging with the politics of youth representation adds to our overall understanding of the overlapping dynamics of inclusion and exclusion, contestation and performance, voice and co-optation at work in the (self-)representations of presumably marginalised groups in global politics.Footnote 93 In the first place, the findings expose a chasm between a liberal ‘opening up’ of international institutions (measured in numbers of non-state actors entering) towards formerly excluded or invisible groups, on the one hand, and the restricted space for political articulation that is offered to these ‘newcomers’ once inside international institutions, on the other. The findings of our analysis thus underscore earlier studies that have identified a prevalent neo-corporatist, output-, and efficiency-oriented rationale driving increasing access and participation of non-state actors.Footnote 94 Give the prevalent framing of youth as ‘not-yet’ experts and given their often limited material resources, our study highlights that youth representation primarily serves the functional demands of IOs for legitimacy. Secondly, even though the downgrading narratives we have identified partly build on age as a basis for inferiority, other studies into the political representation of formerly marginalised groups highlight similar dynamics based on social categories such as race, gender, or socio-economic status.Footnote 95 Our study also underscores the relevance of thinking about the overheated global advocacy market as a ‘shrinking space’. While youth actors benefit from (over-)accessible spaces, they enter the competitive scene at a stage at which actual possibilities to be seen and heard are grossly diminishing. In sum, our analysis of youth representation in global health brings to light a number of diagnoses of the many grievances and pitfalls that non-state actors confront in contemporary global governance.
Moreover, our article offered insights into the specificity of youth as a liminal, transitory constituency – an imagined stage in life that is emblematic of the not-yet and defined by its in-betweenness. We developed the notion of performative liminality to make sense of how, in practice, interviewees who had accessed global health policy events as ‘youth’ exploited the contested boundaries of youth by espousing other (adult) subject positions. Our interviewees rarely identified as ‘just’ being a young person, positioned to represent interests, grievances, and experiences of young people in general. Rather, in many cases, they aspired to be perceived as professionals and experts, and/or identified as representatives of further constituencies, such as a specific gender identity (particularly women), the global south, global elites, peripheries, and so on. In fact, many of our interviewees expressed a sense of unease with regard to the fundamental question of ‘who’ young people speak for in the first place and feelings of ambivalence towards the responsibility that comes with being identified as a ‘youth representative’. Our study thus underscores the ambiguous, shifting boundaries between identities that inform youth engagement in global (health) politics and illustrates how practices of political representation are imbricated with, rather than neatly separable from, adjacent social practices. More importantly, though, these intersecting identities inform the diversity of young people’s experiences inside and outside of international organisations as social positionality affects their possibilities for political representation in multiple ways. With our attention to the manifold barriers and absences that young people experience – and that keep them outside of international organisations or restrict their performative space inside of IOs – we have, in fact, sought to re-balance the over-emphasis on the marketplace of representation in the pertinent theoretical literature.
Finally, the findings presented in this article raise significant points about the practice of youth representation in international institutions that should inform both future research on youth in IR and the activities of international organisations as they continue to accommodate youth in the future. Viewed against the backdrop of the nascent IR research programme on youth that has emerged in recent years, our study shows that, in practice, opening up international institutions to ‘youth’ may mean rather different things across policy fields. In contrast to environmental governance, migration, peace, and security, where youth actors often stand out as a more politically vocal, even activist constituency,Footnote 96 youth representation in global health appears as deeply intertwined with the expert-driven, depoliticised nature of the policy field at large. To put it bluntly, a large majority of the young people we spoke to were well-behaved, biomedically educated, upper middle class aspiring professionals from the global north. Second, our findings highlight the incredible efforts currently undertaken by and for youth actors to ‘mainstream’ youth into the structures of institutions such as the United Nations, the EU, the G7, and G20. The youth representatives we spoke to clearly acknowledged that being identified as ‘a young leader’ is a great ticket to gain access to the world of international diplomacy. At the same time, though, they felt that the very same ‘label’ justified an inferior speaking position, once they had secured access to the realm of international (health) institutions. Furthermore, our study’s findings on the intersectional dynamics of inclusion and exclusion of youth in global health governance have strong implications for the link between the participation of marginalised populations and IO legitimacy. On the one hand, institution-building should be more reflective of these intersectional dimensions, if the inclusion of youth is meant to increase IOs’ legitimacy. This would involve being attentive to the grievances and political articulations of specific groups of young people that continue to be in the focus of IOs (young women; youth from low-income countries; those with a very low average age, etc.), whilst remaining markedly underrepresented in diplomatic discourse. On the other hand, our findings caution against uncritically reproducing IOs’ legitimation narratives about their own inclusiveness. Rather than taking prevalent discourses about ‘engagement’, ‘inclusion’, ‘co-creation’, and ‘meaningful (youth) participation’ at face value, our study illustrates the fruitfulness of sustained attention to the intricate and ambiguous politics of ‘speaking for others’ and of studying representational dynamics in practice as they unfold in salient sites of global governance.
Interviews
Anonymous. Interview 1. 28 October 2021.
Anonymous. Interview 4. 5 November 2021.
Anonymous. Interview 5. 8 November 2021.
Anonymous. Interview 8. 12 November 2021.
Anonymous. Interview 12. 16 November 2021.
Anonymous. Interview 13. 29 November 2021.
Anonymous. Interview 14. 21 May 2022.
Anonymous. Interview 16. 24 May 2022.
Anonymous. Interview 21. 28 June 2022.
Anonymous. Interview 26. 2 November 2022.
Anonymous. Interview 27. 7 November 2022.
Anonymous. Interview 30. 11 November 2022.
Arumapperuma, Thrindra. Interview 28. 8 November 2022.
Beaini, S. Interview 25. 24 October 2022.
Chen, Y.-T. S. Interview 23. 1 July 2022.
Cic, Katja. Interview 20. 23 June 2022.
Ibrahim, S. Interview 22. 30 June 2022.
Kreitlow, A. Interview 11. 16 November 2021.
McGrath, P. Interview 3. 2 November 2021.
Meneses, Paul Darrel O. Interview 19. 23 June 2022.
Ndiaye, Y. Interview 29. 8 November 2022.
O’Sullivan, B. Interview 17. 14 June 2022.
Telakopalli, G. Interview 18. 21 June 2022.
Tmara, A. Interview 15. 24 May 2022.
von Philipsborn, P. Interview 6. 9 November 2021.
Vica, Maria Ines Francisco. Interview 2. 1 November 2021.
Von Polenz, Isabelle. Interview 10. 15 November 2021.
Voss, M. Interview 7. 11 November 2021.
Wong, B. Interview 9. 15 November 2021.
Acknowledgement
We want to thank Felix Stadelmann and Niklas Kramer for being outstanding research assistants for the research project from which this article originated. Earlier versions of this paper were presented at EISA 2023 in Potsdam, ISA 2023 in Montreal, at the 2022 Workshop ‘Contested Futures’ in Berlin, and the 2023 WIRE Workshop in Brussels. As discussants, Alejandro Esguerra and Kristi Heather Kenyon have provided us with particularly valuable comments to improve the paper at these conferences. We also thank our project colleagues Jonathan Josefsson, Eva Lövbrand, Frida Buhre, and Joel Löw for a very fruitful research collaboration and for accompanying us on the way towards publishing this paper.
Open access
