Decolonising Global Health – 12th European Congress on Tropical Medicine and International Health, 28th September – 1st October 2021

By Maisie Jones, Key Correspondent and Professional Intern with the Irish Global Health Network

Date: 09th November 2021

This session was chaired by Professor Bjørn Enge Bertelsen and moderated by Professor Bente E. Moen. The topic of decolonising global health is one that is very much in the spotlight currently. Several articles have been published recently exploring this concept of decolonising global health and how to go about that. This session explored in detail this concept of decolonising global health and examined not only how to do it, but asked the fundamental question; is it possible? 

The keynote speaker, Professor Madhukar Pai, took an in-depth look at global health and how it is dominated by the Global North, with a huge lack of diversity among global health and development organisations. He made the point that global health stems from colonial medicine, which then morphed into tropical medicine, international health, and into global health as we know it today.  

Global health, he argued, was birthed in supremacy, and continues to live in supremacy today. Professor Pai looked to the data on current global health organisations around the world to back up this statement – the Global North continues to hold power through these organisations, with headquarters of these organisations primarily located in Europe and North America.

It is mostly white men in charge of these organisations, with approximately 70% of CEOs and board chairs of global health organisations being men, mainly those from the Global North. Just 5% of leaders are women from low- and middle-income countries (LMICs). Furthermore, the world’s richest countries are in control of the funds, and consequently what they decide as being on the global health agenda is what gets done.  

He also pointed out that the majority of global health conferences are held in the Global North, pointing the finger back at the very conference at which he was speaking, and questioning what is the point in a congress on tropical medicine being held in the Global North, who is the audience, who’s voices are being heard, and what are the barriers for people from “the tropics” to accessing these sessions? Professor Pai left us with the fundamental question; what can we do to tackle these power asymmetries in the discipline of global health?  

Following the keynote presentation there was a panel discussion with three global health and/or development professionals; Tammam Aloudat, Lioba A. Hirsch, and Themrise Khan.  

The panellists were asked if we first need to decolonise ourselves in order to tackle power asymmetries. Panellist Tamam Aludat answered that power asymmetries cannot be addressed unless people examine their own roles. He made the point that the “raison d’etre” of global health is to achieve health equity and improve people’s health and that this regularly fails. He used the example of Covid-19 vaccine apartheid as this crumbling pretence of solidarity. He states that every single one of us is a cog in that machine and can reinforce it or weaken it. Conversely, he makes the point that this idea of decolonising ourselves is risky, because it gives the system a free pass in a sense. It makes us place the responsibility on ourselves as individuals and ignores the systems and structures that are in place to maintain these power asymmetries. 

The panellists were then questioned on the concept of critical allyship and whether it can be a challenge to structural constraints without being individuating. 

Panellist Lioba Hirsch stated that allyship needs to consist of people in power sitting down and being quiet, letting others step forward and speak, diversifying who we invite to speak on certain issues, and generally giving up power; actions that she feels cause discomfort and are unlikely to happen. She made the point that allyship tends to be associated with a feel-good factor, however in reality critical allyship and solidarity costs comfort. Lioba is cynical that critical allyship can truly take place and that global health can be decolonised. 

An audience member posed a question on how to work with partners in the Global South without feeling guilty for being male and white.

Panellist Themrise Khan formed her answer from a human rights perspective and stated that anyone working in a North/South partnership needs to respect the views and opinions from all sides and to be clear on why it is they’re doing what they’re doing. She made the point that if these elements are clear, then this question shouldn’t even arise, as asking these questions automatically assumes that there is a power differential. She reminded the audience that expertise should be taken into account rather than race or colour, that colleagues from the Global South are experts in their field as much as those from the Global North, and that everyone should be on an equal footing. 

This lead moderator Professor Bjørn Enge Bertelsen to discuss the topic of the centralisation of knowledge in the Global North, and he asked the panellists to briefly reflect on the call to decentralise knowledge and whether that should be part of the conversation.  

Tamam Aludat’s response was that we not only need to decentralise knowledge, but also examine what knowledge is valid and acceptable. He advised that we need to move away from this idea that Western philosophy, medicine, etc. is the right way of thinking, and that everything else is marginal. 

Lioba Hirsch agreed with Tamam, and added that she has often observed at conferences such as these, that organisers are reluctant to invite speakers that don’t have a qualification from an institution in the Global North. She felt that this is because we are more comfortable with having a Southern replica of a white European man to speak on these issues than someone who has a different approach or system of knowledge.  

Finally, Themrise Khan expressed the opinion that the issue is not so much decentralising knowledge as it is acknowledging that there are different forms of knowledge, that knowledge exists in different shapes and forms, in different parts of the world, and that that knowledge is equally important and valuable as the knowledge that us in the Global North may be generating.  

Chairperson Professor Bjørn Enge Bertelsen concluded by reminding us to keep these points with us for the remainder of the congress, and to keep having these discussions about decolonisation within the fields of tropical medicine and global health.