Survival of the Greatest: Ego and Elitism in Global Health

By Alex Stoljar Gold

Taken during my month-long internship with Timiskaming First Nation

In my early years of medical school, working with a well-known global health leader in an institution that prided itself on its global health profile, I had the opportunity to gain an outsider’s perspective on the world of global health funding. I was excited to be part of the field, as it seemed to me that this was the medical way of fighting for the least among us, of standing up for the little guy.

In recent years, there has been much talk of the coloniality of global health––how practices derived from colonial times continue to influence global health, giving disproportionate power to a few actors in a few wealthy countries (1). A related phenomenon, but one that is perhaps less frequently discussed, is the extreme elitism, self-importance, and worship of credentials that permeates most of global health. The goal of this piece is to contrast this elitism with two other experiences I have had––volunteering on a food van and visiting an Indigenous community––and to propose that there are other ways of doing “global health.”

From the early days of my global health experience, it was made clear that to be a player, you had to know people. The more connections you had, the more important you were, and the more good you could do for the most vulnerable, apparently. Assistants, who worked hard behind the scenes to support our project, were told that if they didn’t have the name, no one would bother listening to them. The government bureaucrats we presented to were fixated on the “deliverables” that they could market to show their magnanimity. Even the leaders I respected and admired seemed, at some level, to be wrapped up in the game of it, in the who-knows-who. Again and again, it felt like the performance was more important than the content.

I soon learned that while global health is a field that understands itself as fighting for the most vulnerable (and sometimes does), it is also a world of prestigious academic appointments, Twitter celebrities, opinion pieces in fancy journals, and governments putting on veneers of generosity. It is a field intimately linked with what Anand Giridharadas calls “MarketWorld,” the group of successful capitalists who seek to rectify inequality through free-market, business-friendly initiatives, which do not address the root causes of the inequality that they themselves have helped create (2).

I could not help but contrast all this with my time volunteering on the food van with the Montreal organization Dans la rue. The van served the poorest of the city, providing hotdogs and clothing five nights per week. I began volunteering every second Sunday soon after my 18th birthday and was put on a team with two young firefighters who treated me like a little brother. The van was rickety, seemed to be perpetually falling apart, and certainly wasn’t winning any awards for sanitation, but it was a constant in the lives of many who had fallen through the cracks of our Canadian social safety net. Yes, the van provided warmth and some hope to those who used it, but it also provided a link between the poor of the city and those of us who were more fortunate. For the people who used its services, the van was good for the body. For the people who helped, it was good for the soul. What continuously struck me about the volunteers at Dans la rue was their complete lack of pretention: their sense that they were not exceptional––they were not elite, economically, educationally, or otherwise––and they were not complete altruists. Rather, they were normal people doing something they felt was important and worthwhile. There was a feeling of democratic joy on the van, a sense that ordinary people were coming together to do something that was enriching both their lives and the lives of others. This joy made me look forward to volunteering, evening after evening, year after year.

Another experience that deviated sharply from traditional global health was my time with Timiskaming First Nation (TFN). After my first year of medical school, I completed a month-long internship with TFN, an Algonquin First Nation on the Quebec-Ontario border. I lived on the reserve with a wonderfully welcoming family and spent time listening to stories. The community members were fiercely protective of their culture and heritage but also open and warm. They spoke of residential schools, of daily encounters with racism, and of the tyranny of the Indian Act. In universities, there is a tendency toward self-flagellation and verbose apologies for structural injustices, but the people of TFN did not hold me personally responsible for the violence they had suffered. They simply asked that I listen. They wanted me to know what had happened.

It turned out that just about everyone in the community was an activist. The receptionist at the Health & Wellness Centre explained to me that her sister had staged a hunger strike until she met the Prime Minister. Other community members were fighting for survivors of residential schools, and on the highway into the community, there was a billboard with a count of all the children found in unmarked graves. There was not a single community member who did not wear a shirt or have a flag or have inscribed on their vehicle, “Every child matters.” I greatly admired the quiet courage of the people of TFN. Most did not have many letters after their name, but they had an unrelenting sense of justice that – in truth – I have rarely seen in the urban, wealthy, privileged community in which I grew up. I have often wondered how much more quickly change would be effected if the people of TFN were greater in number, had more resources, and had more political power.

Unlike global health elites, volunteers at Dans la rue and members of Timiskaming First Nation were not primarily concerned with their public appearance or careers. They were everyday people determined to do what they felt was right for their communities. It is well-known that systemic injustices, like racism and poverty, lead to poorer health outcomes (3, 4). To fight for social justice, then, is to improve global health. Indeed, the global health leader Paul Farmer contends that global health should be rooted in social justice (5). I would argue that the volunteers and community workers I met provide a model for another way to do global health––one that is not driven by ego and governed by status, but that is more democratic, led by ordinary people with profound conviction.

Works Cited

1. Hussain M, Sadigh M, Sadigh M, Rastegar A, Sewankambo N. Colonization and decolonization of global health: which way forward? Glob Health Action. 2023;16(1):2186575.

2. Giridharadas A. Winners Take All: The Elite Charade of Changing the World. New York: Alfred A. Knopf; 2018.

3. Braveman PA, Arkin E, Proctor D, Kauh T, Holm N. Systemic And Structural Racism: Definitions, Examples, Health Damages, And Approaches To Dismantling. Health Aff (Millwood). 2022;41(2):171-8.

4. Murray S. Poverty and health. CMAJ. 2006;174(7):923.

5. Farmer P. Pathologies of Power: Health, Human Rights, and the New War on the Poor, With a New Preface by the Author. Borofsky R, editor. Berkeley, Los Angeles, London: University of California Press; 2005.