Written by Jyotika Rimal, Advocacy Officer, Menstrual Health/ Hygiene 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 topic has been somewhat creating a buzz, nothing much seems to have changed apart from many individuals coming in solidarity with the idea that in order for global health to be truly decolonized, the power dynamics among institutions need to be equally distributed. The essence of all this has somewhat been lost, since global health organizations working in the developed world still hold the power to make decisions.
As an individual from a Lower-and-Middle-Income Country (LMICs), it makes me angry at how “decolonizing global health” has become nothing more than a topic for discussion in the classroom. In true sense, decolonization in global health would mean for scholars, academicians, researchers and development practitioners from Higher-Income-Countries (HICs) to stop looking at the Global South with a pity lens and to become an ally.
Dismantling the Power Hierarchy
The way “Global South” is looked upon as one big chunk 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 cannot also be impactful and sustainable unless there is participation from development experts from LMICs making decisions for their community. It is also demeaning that local level knowledge are hardly taken into consideration when it comes to making important decisions. How can a group of people who are working from an office at a HIC setting probably decide what might be the correct choice for those living at a LIC without consulting the local population? Why is it that cultural, social and economic differences are hardly taken into consideration while developing plans and actions? This type of donor driven culture not only impacts sustainability of projects and programs but it also makes the local authorities question their own expertise.
In true sense, we will only be able to see the shift in power hierarchies if and when the “Global North” is ready to include expertise from the “Global South”.
Global West Vs Global South Privileges
A few months ago, I read a Forbes piece on the passport and visa privilege in Global Health. For so many times, scholars and researchers from the global south have been unable to participate in conferences and workshop because of limited visa privileges and yet, these programs keep happening in HICs. There is truly a need to acknowledge the fact that it is not easy for individuals 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 about visas being declined keep coming and yet, no one seems to care about it.
And while we are talking about privilege, Canada hoarding Covid-19 vaccines when the world was under the threat of the pandemic sums up the privileges that HICs enjoy. To top it all, there was no shame in donating vaccines that were about to expire soon to African nations. If this is not privilege, what is? Who decides which country’s individuals are more important than the 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 right and those without power have very few (and in some cases, no rights).
We can take an example of how dengue created a chaos in different countries like Nepal, India and Pakistan and took so many lives. But this did not make any headlines in any international newsroom. Ironically, when UK was going through a heatwave, the whole world knew. If this is not global health privilege, I don’t know what is.
Who Gets to Learn?
Knowledge should be accessible and affordable to all, otherwise how will there be an equal society? It is only through knowledge and real-life experience that individuals will be able to make change. No matter how much we advocate for equal access to knowledge, LICs individuals often pay the price for where they come from. Oftentimes, it is the same group of high impact journals publishing important articles and at most times, these are the same ones that take exorbitant fees from readers. Some articles cost as high as $35. How (and why) should individuals from LMICs pay such a high amount to get access to one article? ($1 = 81.18 Indian Rupees, 129.07 Nepali Rupees, 223.01 Pakistani Rupees). Not all universities from LMICs have the resources and money like HICs to help students get access to journal articles for their research. Students from HICs often get access to more learning and resources helping them with their academic capacities and future, often leading them towards becoming leaders in the global health field. Even today, there is hardly anyone in leadership positions at global health institutes with a degree outside of a higher income country.
Talking about inequality is important, but it is more important to also acknowledge the fact that we ourselves are part of the unequal system. Global health may create a buzz on “decolonization” in the coming years too, but unless deep rooted problems are solved, the word will just be another classroom lecture and nothing else. As a researcher from the Global South, it still makes me uncomfortable to listen to western scholars talking 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 organisation.