Written by Jyotika Rimal, Advocacy Manager, Menstrual Health/Health Partners Alliance (MHMPA) Nepal
When the pandemic hit the whole world, everyone realized that global health needs to be “decolonized”. However, in the last few years that this issue has generated some buzz, nothing seems to have changed much except for many people coming in solidarity with the idea that to truly decolonize global health, the power dynamics between institutions need to be redistributed. equally. The point of all this has been somewhat lost, since global health organizations working in the developed world still have the power to make decisions.
As someone from a Low and Middle Income Country (LMICs), it angers me how the “colonization of global health” has become nothing more than a topic for classroom discussion. In the true sense, decolonization in global health it would mean that scholars, academics, researchers and development practitioners from high-income countries (HICs) stop looking at the Global South with pity and become allies.
Dissolving the Hierarchy of Power
The way the ‘Global South’ is treated as one big piece makes it very difficult to prioritize important areas that need intervention. The idea that all LMICs are similar and require the same kind of focus is simply wrong. Global health work also cannot be impactful and sustainable unless there is participation from development experts from LMICs who make decisions for their community. It is also humiliating that knowledge at the local level is hardly taken into account when it comes to making important decisions. How can a group of people working from an office in an HIC environment possibly decide what might be the right choice for those living in a LIC without consulting the local population? Why are cultural, social and economic differences difficult to take into account when developing plans and actions? This type of donor-driven culture not only affects the sustainability of projects and programmes, but also makes local authorities question their own expertise.
In a real sense, we will only be able to see the shift in power hierarchies if and when the ‘Global North’ is ready to include know-how from the ‘Global South’.
Global West vs. Global South Privileges
A few months ago I read a Forbes piece on passport and visa privilege in Global Health. For so many times, scholars and researchers from the global south have not been able to participate in conferences and workshops due to limited visa privileges and yet, these programs continue to happen at HICs. There is a real need to recognize the fact that it is not easy for people from LMICs to spend so much time, effort and money on something they are not sure they can be a part of. Every now and then news of visa rejection keeps coming and yet no one seems to care about it.
And while we’re talking about privilege, Canada accumulation The Covid-19 vaccines when the world was under the threat of the pandemic epitomizes the privileges enjoyed by HICs. Above all, there was no shame donation of vaccines which were soon to expire in African nations. If that’s not privilege, what is? Who decides which country’s individuals are more important than others? Paul Farmer used to say, “If access to health care is considered a human right, who is considered human enough to have that right?” Obviously, those in power have all the rights and those without power have very few (and in some cases, no rights).
We can take an example of how dengue created chaos in different countries like Nepal, India and Pakistan and claimed so many lives. But this did not make headlines in any international newsroom. Ironically, when the UK was going through a heat wave, the whole world knew it. If that’s not a universal health privilege, I don’t know what is.
Who can know?
Knowledge must be accessible and accessible to all, otherwise how will there be an equal society? Only through knowledge and real experience will individuals be able to make changes. No matter how much we support equal access to knowledge, LIC people often pay the price for where they come from. Often, it is the same group of high-profile journals that publish important articles, and more often than not, these are the same ones that receive exorbitant fees from readers. Some articles cost up to $35. How (and why) should people from LMICs pay so much to access an article? ($1 = 81.18 Indian Rupees, 129.07 Nepalese Rupees, 223.01 Pakistani Rupees). Not all universities from LMICs have the resources and money like HICs to help students access journal articles for their research. Students from HICs often have access to more learning and resources that help them with their academic abilities and futures, often leading them to become leaders in global health. Even today, there is almost no one in leadership positions in global health institutions with a degree from outside a higher-income country.
Talking about inequality is important, but it is more important to also recognize the fact that we ourselves are part of the unequal system. Global health may generate a buzz about “decolonization” for years to come, but unless deep-rooted problems are addressed, the word will be just another classroom lecture and nothing more. As a researcher from the Global South, it still makes me uncomfortable to hear Western scholars talk about “decolonization” while taking zero actions.
Please note that blog posts are not peer-reviewed and do not necessarily reflect the views of SRHM as an organization.
