Capitalizing on Illness and Unequal Partnerships: A Reflection on Academic Global Health
By Jordyn Burnett
As my academic year in the Global Health program at McMaster University comes to a close, I am reflecting on my experience and positionality in this field of study. This paper is an honest reflection on some of the problems I perceive in the field of academic global health. I attempt to articulate how our authentic concern for health equity, social justice, and human rights can be undermined by the standard operating procedures within hierarchical structures and systems. Moreover, I reflect on my struggle with the realization that the growing interest in global health has created an industry of making an opportunity out of sick and poor global South communities.
The ethical intentions of academic global health seem to be distant from how it operates in practice. This is not how global health research ought to be; instead of unequal benefits from health research for the global North and South, there ought to be at least equal, if not preferential benefit for the global South, who are in greater need and bear the burden of being the subjects of said research. This reflection aims to discuss how academic global health can capitalize on illness in low-income countries and how global health partnerships may not be mutually beneficial.
Academic global health refers to global health activities taking place within universities and medical schools. The academic funding structures for global health research and the politics intertwined within these financial policies are key mechanisms that are taking global health further away from what it ought to be. Certain funding structures can actually undermine the capacity of low-income countries to manage the projects being done in their communities. Universities have become increasingly interested in advertising their program offerings as “global health” programs since there has been an explosion in student interest (1). The universities themselves are preoccupied with administrative streamlining of their funding for ongoing projects and with finding the most efficient means for transferring large sums of money to their Southern host communities. Accordingly, some university administrative experts determine that the most efficient strategy is to create their own organizations in the form of non-governmental organizations in host communities (1). This effectively removes work from local administrative structures and undermines the capacity of local organizations in the low-income countries these programs are meant to benefit. This is a clear contradiction in the program’s operational intention versus practice.
Some global health programs in universities and medical schools offer clinical volunteer opportunities. The structure of these volunteer programs is often unethical in terms of the partnerships and the mobility that these programs rely on (2). First, global health partnerships are not mutually beneficial. Let us examine the clinical educational opportunities available to the members on either side of the partnership: global North students with minimal clinical experience regularly embark on short-term volunteerism in the global South, where they encounter high numbers of vulnerable people –– often merely for their own interest. The global North volunteer student, with minimal knowledge and experience in clinical care, is provided access to the bodies of sick people in the global South. On the other hand, policies are in place in the global North which forbid foreign medical residents from seeing patients.
In addition to unequal clinical volunteer learning opportunities, the global South experiences inequitable mobility. What we think of as “global health” often relies on people in the global South remaining rooted in place while global North individuals are highly mobile. Ill patients in the global South can be seen as an “opportunity” for highly mobile global North students and researchers to further their careers. Moreover, using the term “partnership” when referring to the interaction between global North academic institutions and global South nations can further perpetuate the exploitation of marginalized communities, as it can imply equality where none exists (2). I believe it is necessary in our field of global health to reevaluate how the term “partnership” is used and how we can restructure future academic global health systems to exemplify true partnership.
Overall, I worry that academic global health may be reinforcing global North universities as the main agents benefiting from global health projects. I have wondered whether I have perpetuated this very problem myself in small ways, such as through my student researcher positions. I question what defines “real” humanitarianism versus exploitation for knowledge gain. For example, was the aim of my past research supervisors to address health inequities or to obtain another journal publication for their resumes?
Unfortunately, I believe we face the reality that self-interest and career advancement are embedded within the structure of contemporary global health. This complicates our goal of advancing health equity, social justice, and human rights and combatting the hierarchical structures and systems in which we operate.
References
Crane, J.T. Chapter 5: Doing Global Health. In: Scrambling for Africa: AIDS, Expertise and the Rise of American Global Health Science. Ithaca, USA: Cornell University Press; 2013 pp. 145–171.
Sayeed S, Taylor L. Institutionalising global health: a call for ethical reflection. BMJ Global Health 2020; 5: e003353.
Jordyn Burnett
is a Global Health master’s student focusing on neglected tropical disease and the impact of global health interventions on health systems in Sub-Saharan Africa. She completed her undergraduate degree in Cognitive Science at Carleton University where her thesis examined the role of certain receptor pathways in diabetes. Her main research interests are in health and human rights.