Updated: Sep 12
Commonly defined as an interdisciplinary field – with disciplines ranging from bioethical sciences to humanities and public policy – that includes practices, studies, and research aiming to improve wellbeing and to achieve health equity of all people worldwide and the sustainability of the planet, global health is the fashion, young, and vibrant health-related discipline in the global north. College, universities, and medical programs have fostered the development of this discipline, particularly with faculty-led trips with students to serve in global health initiatives in low-income countries. There is even a Consortium of Universities for Global Health based in Washington DC, stablished in 2008 with generous funding from The Rockefeller Foundation and the Bill & Melinda Gates Foundation. These foundations, particularly the latter, have significant footprint in global health initiatives through generous donations to non-governmental-organizations (NGOs) and their own initiatives related to global health. The significant impact of NGOs in global health makes scholars and activists Paul Farmer and Jim Yong Kim affirm that “global health should more accurately encapsulate the role of nonstate institutions, including international NGOs, private philanthropists, and community-based organizations” (Reimagining Global Health: An Introduction, p. 10). By the way, they are co-founders of a global health organization: Partners in Health. According to them, actions led by governments and political-bilateral partnerships between nations in health care should be under the definition of international health. These definitions do not matter much for the point I want to discuss here. As a new discipline, it is normal that people, especially scholars engage in discussions about its definition. The questions I want to address are about the approach that most global health initiatives use, where their initiatives come from, who funds them, and the mentality behind all actions. There are questions about methods, leading actors, funding, and mentality.
Global health is necessary for the promotion of justice, health, and wellbeing worldwide. In a globalized world, the relationship between local and global contexts are present as a fact. The COVID-19 pandemic made this relationship explicit. But it existed way before this pandemic. In fact, many argue that this pandemic was possible because of this relationship grounded on structures that sustain the privilege of powerful nations that control a globalized economy to favor their interests. This led to a dismantlement of public health systems and their ability to prevent epidemics around the world to service private healthcare markets (João Nunes, A pandemia de COVID-19: securitização, crise neoliberal e a vulnerabilização global).
Many people think that colonialism ended with the independency of the last African nation in the middle of twentieth century. Historically speaking, political colonialism, understood as the total subjugation of a nation or a people outside Europe by a European country or the USA ended. But honestly, this still exists when one looks, for example, at some Caribbean Islands that are not independent from their colonial power. Let’s assume that colonialism, as total political subjugation, is becoming extinct. However, colonialism is far from its end for the emancipation of non-Western nations and people’s mind. Dependency is a concept that helps us to see forms of colonialism today. Economic and intellectual dependency perpetuates colonialism which countries – the immense majority of them in the global south – continue to suffer from forms of colonial dependency that prevents them from economic development and intellectual liberation in order to keep the status quo and “superiority” of a group of powerful countries, that colonized non-European nations before (and want to colonize now, perhaps the case of China) and are most of them geographically located in the global north.
In his account about the crisis of modern science and his call for an epistemological revolution, Boaventura de Sousa Santos affirms that the fight for emancipation of a post-colonial era collapsed into a time of regulation by the hyperscientification of emancipation combined with the hypermaketization of regulations (Decolonizing the University, p. 08). Modern science – that separated human from nature and subject from object – generated the ecological crisis which the human being is not part of nature, but rather a subject to explore the object nature from a Cartesian paradigm. Moreover, the humans are also divided between subject – the Westerners who dominate this modern mechanist science – and the others – inferior humans who are objects under superior subjects. As Eduardo Galeano says, these others do not have languages, religions, art, culture, faces, and names, but dialects, superstitions, handicrafts, folklore, arms, and numbers; they are nobodies (El libro de los abrazos, p. 59). In her critique to French colonialism, Simone Weil suggests that those who enjoy the force of a colonizing nation do not see the others in the colonies as they are in the same human level of rationality and feelings. To keep this difference that makes the other less human, it is important not to see them. Their suffering is not known, so they don’t suffer like people in Europe (Les Nouvelles donnés du problème colonial dans l’empire français, p. 419-424).
This objectivation of non-Western people and the dismissing of their knowledge and worldview is part of the collapse of emancipation, which, according to Sousa Santos, the knowledge-as-emancipation that aspires to move from ignorance (colonialism) to solidarity conflicts with knowledge-as-regulation, a movement from ignorance (chaos) to order, the movement of modern Western-science. In this conflict, solidarity became mistaken as chaos and knowledge-as-regulation won maintaining colonialism, now as order (Decolonizing the University, p. 57-59). Although, former colonies achieved political independency, they are kept in this order that sustains economic and intellectual dependency. In practical terms, particularly in the realm of mind, we have a paternalistic, patriarchal, and racist mindset that views everything outside this Western framework as inferior in need of mentoring to create certain levels of progress. Progress means develop and think as Western nations, but never to the point to achieve their level, otherwise they can lose their hegemony and status quo.
Where is global health in this equation? My four questions at the beginning are about: methods, leading actors, funding, and mentality. Answering these questions means: understanding the methods of global health initiatives; knowing who the leaders of these initiatives are and where they come from; from where comes the money that funds these initiatives and leaders; and the mentality that shapes a worldview responsible for sustaining all the above. When we look at the details of global health, led by Northern nations, through people who are from the North or shaped by the “superiority” Cartesian Western sciences, and funded by billionaire philanthropists from rich nations, we start to question about a possible relationship between global health and colonialism. Take a time, to think about these questions. I am doing the same and I will present my thoughts in my next post.
P.S.: To provide you more food for your critical reflection on global health, I suggest you listen to this podcast of a case that occurred in Uganda. I also suggest this article on ethics and equity in global health.
*Alexandre A. Martins is 2021-22 Hubert Müder Chair in Health Care Ethics at the Albert Gnaegi Center for Health Care Ethics - SLU; an assistant professor at Marquette University in Wisconsin, USA. Author of several articles and books in social ethics, bioethics, and global health, such as Covid-19, Política e Fé: Bioética em diálogo com a realidade enlouquecida (Gênio Criador, 2020); The Cry of the Poor: liberation ethics and justice in health care (Lexington Books, 2020)