Posted on 7 July 2020
Walter Mignolo, William H. Wannamaker Professor of Romance Studies and Professor of Literature, Duke University
Amy Locklear Hertel, Chief of Staff to the Chancellor, University of North Carolina at Chapel Hill
Madhukar Pai, Director of Global Health Programs, McGill University
Meleckidzedeck Khayesi, Technical Officer, Social Determinants of Health, World Health Organisation
Eugene Richardson, Assistant Professor, Global Health and Social Medicine, Harvard Medical School
Deborah Jenson, Professor of Romance Studies, Duke University
Sanjoy Bhattacharya, Professor of the History of Medicine; Director of the Centre for Global Health Histories; Director of the WHO Collaborating Centre for Global Health Histories, University of York
Allysha Maragh-Bass, Behavioural Epidemiologist and Clinical Sciences, FHI 360
Seye Abimbola, Senior Lecturer, University of Sydney; Editor in Chief, BMJ Global Health
Dr Mignolo began the seminar by examining the concept of “decoloniality.” He said the process requires allowing people who have been oppressed by colonialism to re-enact their own narratives and histories and delink themselves from western ways. He warned that despite the good intentions of global health advocates, they must be careful not to integrate others into their own “normative ground.” Humility is essential, he said, if people are to heal “colonial wounds” through a process of personal and political vindication that is separate to western frameworks and conceptions.
Dr Locklear discussed her efforts to enhance inclusion at UNC-Chapel Hill. It requires, she said, the sharing of power and privilege. In her work, she has seen how exclusion manifests in real outcomes such as unappreciated work, tokenism, microaggression, and minimal mentorship and promotion opportunities. Excluded people are left out of research, she said, as well as policy, and resource allocation. In her efforts to foster inclusion at UNC-Chapel Hill, she and others have established multiple centres for diverse groups of people so that all members of the community feel they have their own space and a sense of belonging.
Dr Pai challenged the idea that global health is equitable. If it were, he said, individuals and institutions from high-income countries would not dominate global health research and activities. Citing his own small-scale investigations, he showed that most major global health organisations are headquartered in Europe or North America with board members living in wealthy countries. Funding, he said, also comes from the United States, the United Kingdom and philanthropists in these parts of the world. Similarly, research is led by institutions based in high-income countries and he quoted studies that show how scholars in less developed places are invariably not lead authors of research conducted in their own nations. Reversing this, he said, would require scholars to “lean out” of activities that enhance their own work and to promote the skills, contributions and opportunities of others.
Dr Khayesi discussed the concept of “tacit knowledge” which he said was under appreciated in health policy. He described it as knowledge that is highly personal and gained over a person’s career. Usually taken for granted, tacit knowledge is not valued as much as “codified knowledge” found in published work. He said that we need to rethink what types of knowledge we respect and urged global health scholars and practitioners to commit to harvesting local, tacit knowledge in their efforts to decolonise global health.
At the start of the second seminar, Dr Richardson questioned the concept of “expertise” and “empiricism.” Drawing from his medical and anthropological work with humanitarian organisations, he outlined how empirical research can mask or omit information on colonial history, political economy, and exploitation. These all contribute to public health emergencies, he said, but when ignored can reinforce imbalanced power relations, despite the good intention of researchers and public health experts.
Dr Jenson mainly focused on the legacy of US colonialism in Haiti and what this meant when the country suffered a devastating earthquake in 2010 and a subsequent cholera outbreak. For years, US media and western countries did not acknowledge that the disease was brought to the country by United Nations peacekeepers, so entrenched were assumptions about Haiti. Similarly, scholarship produced by Haitians has been disregarded. For example, the origins of ethnopsychiatry in Haiti, which she said, is extremely useful for conceptualising global mental health.
Dr Bhattacharya discussed the tendency of historians and analysts to write colonised versions of global health. These simplified accounts focus on small groups of people in places of power, he said. They do not investigate the complexities of implementing health programs. Pointing to his work on the eradication of smallpox in South Asia, Dr Bhattacharya demonstrated how the history of such a program is more nuanced and complex than analysts had previously acknowledged. He investigated how the campaign was designed and implemented outside of places like Geneva through regional autonomy and collaboration. More representative and accurate history can be written, he said, if we pay attention to archives and voices that are often ignored by investigators.
Dr Maragh-Bass’s work focuses on HIV and stigma in the United States. She discussed the power structures inherent in health research. Simple things like terminology can hurt communities or create mistrust. She also outlined how funding, timelines, volunteer work, and tokenism exist in research and can perpetuate stigma. Researchers can also mistakenly assume they understand the community they work within, she warned. Dr Maragh-Bass ended by recommending community-based participatory research (CBPR) as a useful framework for global health research.
The final speaker of the day was Dr Abimbola who offered a reflection on the meaning of “decolonising global health.” He expressed his concern that the concept could become meaningless, even a buzzword, and suggested ways to avoid this. Taking local knowledge seriously; accepting that many opposing views can exist at once; acknowledging that inequity exists within groups, not just between high-income and low-income countries; valuing informal knowledge; and avoiding binary divisions between the ‘local’ and the ‘foreign’ were some ideas he recommended.
Overall, the conference was a great success and the Centre for Global Health Histories at the University of York is extremely grateful to all speakers and to student organisers: Yadurshini Raveendran, Laura Mkumba, Andrea Koris, Ali Murad Buyum, and Cordelia Kenney for their tireless work to coordinate the event.
As always, we thank the Wellcome Trust for their sponsorship and for making our Global Health Histories seminars possible.
Event report by Alexandra Bradbury, MA student (Medical History and Humanities), University of York.