On May 16, 2023, UW Department of Global Health welcomed Dr Madhukar Pai, MD, PhD, Canada Research Chair in Translational Epidemiology & Global Health and Associate Director of the McGill International TB Centre to partake in the Stephen Stewart Gloyd Endowed Lecture Series where he presented his talk titled "Can We Walk Our Talk on Decolonizing Global Health?"
Madhu opened his lecture by introducing himself and his unique position as a double agent in the field of global health before sharing how he sees the field of global health today.
He challenged us to walk our talk on decolonizing global health and examine how we shift from global health as a charity case to global health as justice and to explore how we shift from global health as white saviorism to global health as allyship.
Global health keeps failing on health equity for citizens of the Global South
Dr. Pai helped us first look at inequity in global health by examining the handling of the Covid pandemic. The COVID-19 pandemic was declared a pandemic no more by the World Health Organization (WHO) in early May 2023, yet 2.3 billion people across the globe still have not received the first COVID-19 vaccine dose. “A colossal failure of equity,” Madhu stated, “how can practitioners in the global health field look at themselves in the mirror and say, “we’re all in this together” when this gross level of inequity is staring right back? Are we really in this together?;
Inequity in global health is more than equitable access to vaccines and medical advancements. It includes decolonizing the current visa apartheid situation, examining current global health power centers, reviewing the makeup of leadership within the global health field, thinking more critically about diversification within grant funding, and reconsidering journal authorship.
From provosts to presidents and corporate VPs, there is a lot of talk on DEI and decolonization, but is there action taking place?
Diversity, equity, and inclusion (DEI) is a popular topic of discussion in the workplace among US adults and university faculty. There are provosts focused on implementing this work at universities and initiatives under review at institutions across the globe. There are DEI-focused pledges being made by university presidents and global health organizations across the globe, but is global health actually walking the talk? Insights gathered from the editorial board of Global Health Research and Policy during a 2021 symposium show that the paradigm shift is still pending. As of mid-2023, DEI efforts are under attack at some US higher education institutions while being lauded at others.
The global health field itself is inequitable, dominated by those with power and privilege
Dr. Pai posited that the paradox of global health is that all of global health was born out of white supremacy and colonialism, and to this day, society continues to replicate systems of coloniality. Because of this, global health must be reviewed through lens of power. He noted “If you don’t understand power, you can’t penetrate what’s wrong with global health.”
How does power present itself in global health? Over 80% of headquarters offices of organizations active in health and health policy are in Europe and North America and of 20 directors and chairs of these global health organizations, 17 of them are nationals of high-income countries and 14 of 20 are men. Additionally, 70-80% of global health funding goes to health- and health policy-oriented organizations located in the Global North. Some global health practitioners refer to this lopsided distribution of funding, where money is primarily used to fund the operation of global health organizations, as phantom aid. Eventually the remaining 20-30% of funds will trickle down to the organizations which they are specifically meant to support.
Global health will repeatedly fail on equity, unless we shift from charity to justice and from saviorism to allyship
Dr. Pai’s lecture highlighted how current global health issues seen in the Global South are often linked to Global North actions, inactions, or experiences; the most prominent of which are: Global North citizens lacking lived experience, privilege clouding one’s view and preventing an issue from being seen clearly, being physically very distance from the real problems and real solutions, human nature to make mistakes – even with the best of intentions, centering oneself, a need to continuously feel generous (circling back to white saviorism), and importantly, failing to address the structural issues (structural racism, among other components) that allow for the cycle to continue. The job of an ally is to ask "what is wrong with this picture? Fundamentally, structurally, something is broken. I want to fix that."
To walk our talk on decolonizing global health, we need to fix a broken system. For the Global North, that means shifting power and moving away from white saviorism to allyship. How can we partake in the shift of power? Dr. Pai reminded us that “power never concedes by itself” but it is necessary for the Global North to be an ally, not an obstacle, to the Global South.
Walking the talk of decolonization is hard, but possible
Madhu emphasized his point stating that the only way to achieve change is to bring people together, through mobilizing or organizing, harnessing the power of many for change. Additional emphasis is given to the point that we must get political to solve things.
There will be no change without political action and concentrated efforts to dismantle current systems and structures of power and privilege as all of this is critically important in geopolitics and for overcoming obstacles of global health action. This will take us closer to a world that Dr. Pai describes as one “where we don’t need charity at all.”
History of the Stephen Stewart Gloyd Endowed Lecture Series
The Stephen Stewart Gloyd Endowed Lecture was established in 1982 to recognize Dr. Park Willis Gloyd. The lectureship was renamed by the family to recognize Park’s son, Stephen Gloyd, who is the Director of the Global Health MPH Program in the UW's Department of Global Health where he directs efforts to expand curricular options to address global workforce needs.