Remedies for a Colonial Hangover
For those of us in the global health or broader international development field, our personal reckoning with the realities of social inequity and injustice may take on some additional dimensions. For most of us, the core guiding light of why we do what we do is a commitment the principle of equity – in access to maternal health services, in malaria prevention treatment, in the ability to earn income, to use communication technology, to learn. It can be hard to acknowledge that the very field in which we have invested years of passionate effort may be at best, riddled with anachronistic and offensive terminology and at worst, actually be further exacerbating inequity.
There’s a lot to learn from and listen to as we strive to achieve the equity goals inherent in global health work and to do so in a way that is, in and of itself, equitable. We’d like to share an (albeit incomplete) roundup of a few resources that we’re taking to heart.
The first is the powerful and pragmatic keynote address by Solomé Lemma, Executive Director of Thousand Currents, as she opened the 2020 Global Health Council Summit this past November. During the session titled “Welcome & Unpacking Race, Privilege, and Intersectional Bias as Drivers of Global Health Policy,” Lemma’s remarks were jam-packed with concrete directives for decolonizing the field and grappling with racism and intersectional bias. Lemma encouraged us to “name the harm and own the responsibility,” and to “locate (our) work in historical and political context.”
Among other key takeaways from the Global Health Council Summit, here are four concrete actions that we can make progress on starting today:
Making indigenous ownership and leadership the standard – not the exception
Compensating local partners in the Global South at the same rate as their Northern counterparts
Questioning what is happening in our own organizations, including rethinking who we choose to hire, promote, and elevate as experts
Sitting in our own discomfort and making the space for change
Second is the Racial Equity Index’s Global Mapping Survey to explore the dimensions of racial equity to help the sector create a true and authentic index and definition of racial equity for the global development space. The survey recent closed and analysis is underway. We look forward to sharing the results with our networks widely and hope to prompt frank and transformative dialogue.
On the topic of digital health specifically, it has become clear in the last several years that technology is neither equal nor equitable. Women often cannot access tech due to social norms and deep-rooted gender biases. Women who try to break out of the expected confined behaviors may face intimate partner violence or other unintended consequences.
USAID recently created a Gender Digital Divide Primer to introduce their staff to the basics of the impact of the effect on women by the digital gap. They broke it down succinctly:
The 4As: Affordability, Availability, Ability, and Appetite
Affordability: Due to income variations, women have to spend more of their income on technology, which is a disincentive
Availability: Even when you have a country like India with 100% coverage, women may still have issues accessing smart phones
Ability: Tied to digital literacy. Often kept out of the same educational access to learn new technologies
Appetite: Meaningful resources for women online. If the content isn’t created by women, it often won’t appeal to women. Not marketed to women
Speaking of technology, a recent letter to the New England Journal of Medicine, “Racial Bias in Pulse Oximetry Measurement,” offers data that shows that “in two large cohorts, Black patients had nearly three times the frequency of occult hypoxemia that was not detected by pulse oximetry as White patients.” We cannot ignore the importance of who has a seat at the table during the entirety of the research and development lifecycle.
In an effort to further interrogate these topics and learn from the experts we recently convened a panel at the Global Digital Health Forum entitled “Using Digital Health to Help Dismantle Barriers to Health Justice.” The session was facilitated by Crystal Lander, Executive Director of Global Affairs for Pathfinder International who was joined by panelists Dr. Tabinda Sarosh, Country Director, Pakistan, Pathfinder International; Dr. Diana Nambatya Nsubuga, Regional Deputy Director, Policy & Advocacy; Africa Universal Health Coverage (UHC) Co-Chair, Living Goods; and Clare Winterton, UNWomen Senior Advisor, Strategic Communications and Stakeholder Engagement for the Generation Equality Forum and Action Coalitions.
We asked the audience, “What are the next steps that we as a digital health community need to take to move towards digital as a tool for health justice.” Responses came quick and fast, and included:
“Be inclusive not only in works, but in actions such as in planning, designing, implementing, and evaluation!”
“Provide deeper analysis and guidance on how to implement the digital development principles in a way that gets us to justice.”
“Don’t work with Facebook and other companies that profit from inequity.”
“Really think about potential unintended consequences and don’t proceed with design until you’ve planned for them.”
“Learn lessons from the gender justice community.”
“Create a better understanding of the intersectionality of race, ethnicity, and gender in the communities where we are working.”
“Expand stakeholders! Be more inclusive and ensure communities are at the table.”
What does this say? I think that we have a long way to go.
And finally, this quote from Ann Hendrix-Jenkins, advocate, researcher, author, and team member at The Movement for Community-Led Development.
“Whichever language we use, the words we select have ‘steering effects’ on roles and relationships, power differentials, and how activities and priorities get valued or ignored. At present, the many familiar terms and concepts in common use don’t set the stage for community-led development. They preclude co-creation among equals by impeding the recognition of people as experts of the own worlds, skewing power dynamics, and eroding the potential of independent, self-directed collective action.”
No doubt, there’s much to learn and onboard as we truly commit to dismantling the systemic determinants of inequity in the global health work that we do. Stay tuned as we sit in this discomfort and make the space for change. Pull up a chair.