Debotri Dhar | Possibilities and challenges of the global health agenda

Coming at a time of devastating wars, it can be easy to miss a landmark global event such as the World Health Summit that was recently convened in Berlin from October 15 to 17. Along with the director-general of the World Health Organisation (WHO), the summit hosted diplomats and policymakers from around the world, including ministers of health, economic development and women’s well-being, the leadership of Unicef, UNFPA, the World Bank, the World Medical Organisation, USAID, the European Commission, the G-7 and G-20 health and development partnership, founders of health-related organisations, and other international experts. Held every year in Berlin since 2009, the theme for this year’s summit was “A Defining Year for Global Health Action”. The discussions were informative, often inspiring and, in some instances, refreshingly candid, touching a raw nerve among those who have had similar experiences, a point to which I shall return as it is central to the summit’s focus on global health equity.

The summit’s slew of panels included important themes such as human-centered health coverage, effective financing models for healthcare through public-private partnerships, closing the gender equality gap with a women’s health agenda and the launch of the Equity 30 Alliance to empower and create self-care opportunities for women and girls, fostering health systems in conflict-affected countries and humanitarian settings, the dynamics of race in global public health, innovations in mental healthcare to reduce the treatment gap, new technologies and digital healthcare, pandemic preparedness, region-specific experiences for global health policy including the Asia-Pacific, academic-community collaborations, the role of national health institutions in linking research with evidence-based public policies, and pathways for global cooperation.

The discussion of race in global health equity was perhaps among the hardest, along with discussions on partnerships involving academia. Loyce Pace, the United States assistant secretary for global public affairs in the department of health and human services, described race-related conversations as difficult but necessary. There are many good stories to tell, including successes during the Covid-19 pandemic, but “beware the rewrite”, she said, pointing to a global history of how innovations available in higher income countries not being made available to poorer nations was true even in the recent pandemic responses. It is telling that the natural and human resources of the latter were exploited for centuries by the former, through colonialism. Ms Pace said she had never experienced a race-neutral world, emphasising the need to say the quiet parts out loud. One of these has to do with continuing colonial practices within Western academia, such as of erasing the work of women, racial minorities, and those from the Global South, especially individuals with relatively less power, painful experiences that several academic colleagues who have been in similar situations also shared.

An example from my own journey is of a panel I had organised in my area of expertise, inviting national and international experts -- all women, with women of colour in the majority. Not just regional but also thematic experts, on a topic related specifically to women’s experiences, the panelists had testified on high-level foreign affairs committees, served as diplomats, coined terminology, and contributed to teaching, writing, research, and policy engagements. A senior female colleague pointed out how the senior white male director of the international policy unit had named only himself as the faculty expert in his unit’s event description. The question was raised again, by a co-panelist. “So, gender, race and power don’t matter in universities?” I was sent nearly a dozen screenshots, in which earlier presentations by even tenure-stream women of colour faculty, as also experts from outside academia, also named only him as the expert.

Scrambling for a diplomatic resolution, I offered many explanations, including that another centre had mentioned me as the faculty expert for a policy talk. I also praised him to the audience, and shared his verbal and written appreciation of my expertise and work. “How convenient,” came the response. “He gets to be the expert, and if anything goes wrong you take the fall.”

Whether or not this was true, the issue came up again when I served as faculty adviser for a policy research project, where only two white women mentoring similar projects were publicly, and in one instance profusely, recognized for their work and leadership, despite the government’s own project description mentioning our work as advisers -- without, to my knowledge, any discrimination on the basis of rank, race, or citizenship -- from getting in touch with policymakers to more than a semester’s work with the student team, teaching, guiding research, sharing readings, holding meetings, and coaching for presentations.

Animals, including organisational ones, act for different reasons at different times: foxes are cunning and bugs will bite. While I exercised discretion in certain matters, for my institutions, colleagues and friends, this is a bigger issue pertaining to hierarchical, exploitative practices in academia. Appropriating or erasing the uncompensated, months-long additional work of some employees and highlighting others, while dehumanising for anyone, speaks very differently to those with diverse histories, and is quite traumatising. Hence the summit’s discussion of stress and trauma caused to vulnerable individuals and communities due to extractive practices was on point, intersecting as it does with gender, race, citizenship, and community-academia partnerships, at a time when the latest inclusivity index ranks the United States 118th in racial inclusion. Unfortunately, when a handful of powerful white individuals focusing on the Global South engage in such practices and are vigorously promoted by their institutions, observers conflate the two. The unethical response would be to use institutional pulpits to continue to bully, intimidate and threaten. The ethical response, especially when these and other exploitative acts were clearly not happening for the first time, is to self-reflect and course-correct.

The final day of the summit aptly focused on leadership, such as through a session on effective leaders for health systems to improve the quality of life and well-being of populations.

Quoting WHO, a youth leader highlighted how the health of all people is fundamental to the attainment of peace and security, and the role of good leadership. While disagreement is a part of democracy, not everyone can lead on every issue. At a minimum, global institutions do need leaders who do not erase or devalue the labour and humanity of their less powerful institutional colleagues -- regardless of identities -- let alone local community experts and international partners, leaders for whom ethics is more than just a word on their professional profiles.