The current power dynamics in global health are a barrier to achieving health equity, partly because too many high-profile politicians are simply reluctant to listen to, or act upon, scientific evidence, and partly because of countries and institutions that wield disproportionate influence in today’s global health architecture aren’t willing to relinquish their power: a left-over of colonial influences.

At the Geneva Health Forum session on Wednesday, ‘How do We Decolonialise Global Health?’, Sarah Hawkes, director at the Centre of Gender and Global Health, asked: “Why don’t people, particularly in political circles, use the evidence that’s in front of them?”

Hawkes urged that people in the global health sector need to evaluate “how we’ve ended up in a situation where very powerful political stakeholders are seen as anti-evidence and anti-science”.

Further confounding matters, she added: “We have ended up in a position in 2020 where those people with political power are not necessarily the same or equal to those with financial power.”

Health Equity – A Fragile Concept

Tammam Aloudat, Senior Strategic Advisor Access Campaign at Médecins Sans Frontières (MSF), noted that populist politics also have made health equity a fragile concept.

And since financing and funding still determine many aspects of delivering health, he added: “What stands now is a set of norms that allocates resources, and that is controlled by power hierarchies, that can aim as much towards perpetuating their own power as towards improving health and prosperity.”

Global health is also acting out of a legacy of colonial influences, where rich countries dominate policies that determine how key health investments are made, and where distribution of health products may take place.

“Rarely has any colonial power, in classic colonialism, given up its position of power willingly by the kindness of their hearts,” Aloudat said.

Historically, those holding power relinquished control “because [they were] incentivized” one way or another. Without proper incentives, he argued, it may be difficult to convince countries and institutions that wield outsized power in the present day global health arena to commit to real health equity.

This is evident in the burgeoning debate over the fair distribution of COVID-19 vaccines. Two vaccines have now been reported to have an efficacy of greater than 90%, but how and when these will be administered in low- and middle-income countries (LMICs) remains unclear.

Stakeholders Must Acknowledge Global Health’s Colonial Legacy

In any case, it is important for stakeholders to acknowledge that global health’s legacy “isn’t all good and fuzzy”, keynote speaker Dr Mishal Khan said.

Khan, an Associate Professor at the London School of Hygiene and Tropical Medicine (LSHTM), said that global health players need to start thinking about how decolonisation could be framed, she added. Currently, it is proffered in a way that is so “naive” as to assume that everybody is on board and everybody cares.

In early November, when Khan spoke to Health Policy Watch, she noted that while colonialist influences in global health are ubiquitous, the issue still hasn’t attracted sufficient attention.

At the GHF session, she clarified that stakeholders in the health sector need to be “very clear on imagining what sort of new global health we want to see, and then looking into organizations and asking them what they are going to do.

“What steps are you going to take as an organization to become closer to that?”

Open Dialogue Needed On Decolonisation

Open dialogue and a commitment towards decentralisation are key to tackling colonialist influences, the panelists also stressed.

Seye Abimbola, Editor of BMJ Global Health noted that an ‘open dialogue’ process would provide clarity on what changes stakeholders want to see, first of all.

“Getting clarity on what the change looks like is an incentive because it can help galvanise energy behind goals. Imagine what that world looks like, and start taking concrete steps,” Abimbola said.

COVID-19, moreover, has presented an opportunity for global health actors to realise that decentralizing power is feasible. For instance, Geneva’s global health organisations have been forced to shift more staff and responsibilities from headquarters to national and regional offices, as a result of travel restrictions that have dramatically curbed international travel.

More Acknowledgement of ‘Shared Burden’ of Universal Health Coverage Goal

The panellists also noted that the pandemic has strengthened awareness about the importance of universal health coverage (UHC) – among both rich and poor countries – in order to stave off future health threats.

Whereas “global health” used to be seen largely as a system to enable developing countries’ health systems, the pandemic has revealed – to many for the first time – that there are big gaps in UHC in developed countries as well, said Emanuele Capobianco, Director for Health and Care at the International Federation Of Red Cross And Red Crescent Societies.

“We are very passionate about UHC breaking away from an oppressive way of thinking. UHC breaks away from that, bringing issues of access to healthcare. From Malawi to Switzerland, health access predominates in the COVID pandemic,” Emanuele said.

Image Credits: Geneva Health Forum.