What is social justice in global health? Answering this question is more than an academic exercise. It has real world implications for the equity and wellbeing of historically marginalized communities.
“Who defines what the problem is, who decides what to do about that problem, is where I find the biggest problem in the landscape of global health,” said Kenneth Mugwanya, an assistant professor of global health and associate director of the International Clinical Research Center at the University of Washington. “Most problems tend to be defined by the Global North, not by the people who the solution is going to benefit. That alone creates social injustice in the system.”
Concepts like anti-racism, decolonization, and equitable partnerships are increasingly part of the narrative of global health, but there is no clear consensus how best to define or address these issues. During the 2022 Global Health Visit Days, we convened a panel of UW faculty to share their insights on how to think about and integrate social justice into a public health career.
Panelists included Keshet Ronen, an acting assistant professor of global health who focuses on the use of mobile communication technology to improve behavioral health in marginalized and underserved communities; Angela Micah, an assistant professor at the Institute for Health Metrics & Evaluation who specializes in tracking development assistance for health and evaluating health financing policies in low- and middle-income countries; and Kenneth Mugwanya, whose research analyzes the intersection of reproductive health and HIV prevention. The panel was moderated by Steve Gloyd, a professor of global health and associate director of the MPH in Global Health program.
Below is an abridged version of the conversation. Answers have been edited for length and clarity.
Steve Gloyd: What is social justice in global health and how do you address it within the context of your work?
Kenneth Mugwanya: I view social justice as understanding that individuals in a society should be able to live in harmony with a common goal, but also be afforded equal rights and opportunity. One of the things which I want to be clear when we talk about social justice and equity is that people are at different stages. You can't give the same amount of opportunities to everyone and in that way think you’re going to bring up everyone. The distribution of services and opportunities needs to find people at the level at which they are so that they eventually can be able to compete equitably with other groups.
Angela Micah: When I think of social justice in global health I think of it from a perspective of the global burden of disease and how that relates to global health spending. A large amount of the spending on health is in high income countries and the larger burden of the diseases is in low- and middle-income countries. My work focuses on resource tracking with a personal idea of making the world more aware of where we are putting our resources and hopefully more accountability, more realignment of resources.
Keshet Ronen: For me, social justice is really centering those whose power has been disregarded.
When I was in the lab I just felt so far from this idea of social justice and so I moved more into public health and have tried to pursue projects where I’m working in partnership with community. It's also pushed me to get more involved with institutional social justice work, thinking about how we bring those values into how we do our work within our institutions and into our classroom conversations.
SG: What pitfalls have you seen in your day to day work in terms of moving towards justice, and how can they be overcome?
KM: How you define the problem is going to dictate where the resources go and, subsequently, the impact which is going to come from them. However good intention that solution may be, it may not have the desired impact because you didn't involve the groups on the ground who in their own sense know what the problem is and know the potential solution but may not have the resources or the means to come out of that situation. Part of it is really understanding how to create partnerships between the North and the South which are respectful and understanding. These are structural things in place for so long they are harder to change. We have to be patient but persistent in our pursuit of social justice.
AM: All the issues Ken highlighted – long-standing challenges to the way aid is allocated and how that reflects donor countries own national interests – one maybe positive awareness that the COVID pandemic has helped us achieve is the popularization of the idea of a global public good. Given how easy it is to move around globally, high-income countries cannot just shut themselves off. Inevitably a problem somewhere far off will show up at your doorstep. Whereas before it might be harder to explain to policymakers, or even citizens, why it's important to be concerned about what resources other people have, especially to support health related activities, now we have a very real example to point to.
SG: How do you balance dealing with issues of racism, power, and privilege within your job and in communities outside the job?
KR: For me, there is resilience in resistance. To leave the institutions that feel oppressive and be out in the world in the communities that I feel connected to is restoring for me. I don't think of them as equal sources of burnout, but there are also only 24 hours in a day. What’s important is finding ways to do social justice work that feel like they tap into your resilience rather than draining you constantly.
KM: For most academic institutions the faculty composition is a little skewed. Just my mere presence as faculty is a huge representation for people who are coming through the ranks. What do you do when you are in such a position is a big ask, because you have so many people who look up to you, and they do come knock on your door for guidance and wisdom. You have to create a critical mass around common ideas to be able to have meaningful impact. You have to be part of the movement, you can't achieve this as an individual.
AM: For a while something I struggled with was having an interest in using whatever resources I had to support the betterment of Africa and feeling like I still wanted to live abroad. One way that I make sure I never lose sight of that personal mission is to maintain very active relationships with people, both on a personal basis back home, as well as for my academic work with people in universities in Ghana and other African countries.
SG: What has surprised you the most around your social justice work in your field, particularly with respect to power, privilege, racism, etc.?
AM: Even in my position, I have a lot of privilege. My positionality has its own questions, but I aim to speak up to bring other issues, especially from low- and middle-income countries, to the table for discussion. Not necessarily aiming to be the sole representative, but I think there are certain things that, not having had lived experiences, are not immediately apparent to others.
KM: I’m optimistic, in part, because social justice is being discussed now. It’s on everyone’s agenda. That alone is a small progress but a progress in the right direction. What gives me a lot of energy is most of this movement is really driven by young people, most of these changes and all the discussions are being driven by young people who are challenging the status quo.
KR: I totally agree, Kenneth, that it's been really encouraging to see this surface as a conversation. One thing that has surprised me is how many people are now willing to talk about colonialism, are now willing to talk about racism. Sometimes we think, Am I the only person who sees that something here feels wrong? And actually lots of people do, which can be really reassuring.
SG: How would a public health researcher evaluate the extent to which recipient communities feel social justice has been it has been achieved and achieved sustainably in global health?
KM: I don’t really have an answer for the evaluation, but I think involving the communities in whatever work you do from the inception, to me, is more important than anything else. That is the goal - aim to have the people your plan is targeting involved in all the activities right from the inception, and understanding what you want to do and whether that fits into their expectations.
SG: How do you balance your efforts to achieve social justice without appearing to be radical, and how can this affect your career growth?
AM: In life, you have only one life to live and you have to try your best to live a life that you will look back on and be happy with yourself. What is career progression when you have progressed and you’re unhappy because you're doing things that are not aligned with your core values? Your personal integrity is priceless and I wouldn't let anything compromise that.
KR: The one thing I would add is different people's positionality and access to power and privilege determines what types of risks they can take. It’s also important to know that sometimes it's okay to just keep quiet because it's just too risky given your positionality and your power. We all need to strive to be like Angela and truly embody our values and take risks, and we also have to give ourselves grace. I say this as someone who is afforded a lot of privilege as a white person and we don't all get that.