BY ALICIA DING.
In “Towards a common definition of global health,” written in a 2009 edition of the Lancet, members of the Consortium of Universities for Global Health (CUGH) Executive Board defined it as “an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide.”[1] Perhaps it is appropriately vague to accommodate all of the various ways in which people “do” global health, which includes working with Non-governmental Organizations (NGOs), increasing awareness of a cause, figuring out more effective ways to distribute and equitize health resources, and forming partnerships between high income countries and low-and-middle income countries.However, global health, at its broadest definition, is essentially nations helping each other solve issues relating to health.
As a result, partnerships have grown in popularity, but they often emphasize the shortcomings and at times one-sidedness of global health. It is often industrialized nations that determine the terms of a partnership and then base definitions of global health off of these working relationships.[2] In addition, most of the panels that have gathered to discuss the goals and objectives of global health partnerships consist mainly of members from high income countries and not their low income counterparts. This was seen most notably in the CUGH conference that took place in 2008, on which the 2009 Lancet article based its definition of global health. Only four out of the 50 conference attendees represented “partner” institutions, while the others were all from the United States or Canada.[3] One of the “partner” institution representatives pointedly asked if the only way for them to implement partnerships was to “look for an even poorer country to work in.”[4] Although the report of the meeting acknowledged that there were still conflicting attitudes towards partnerships (with the “partner” institutions feeling less approval than the US and Canadian ones), the 2009 Lancet article did not mention this.[5]
Thus, the inequality in partnerships does not necessarily stem from the direct benefits that both nations receive, but from the positions in which the partnership places the member countries. However, this inequality may be unfortunately inherent in any global health practice because of the connotations of helping another nation. Receiving help means acknowledging that a problem exists and often implies that the nation does not have sufficient resources or means to solve the problem on its own, and providing help comes with connotations of having both the knowledge and abundance of resources to aid another nation. Because global health also developed from imperialistic roots, it is still challenging for “helping” nations (often western ones) to avoid having these connotations.
How, then, can one nation aid another without seeming paternalistic when paternalism always seems to be implied in helping? Consulting the nation being helped is clearly an obligation. The increase in popularity of partnerships shows that nations involved in global health genuinely have good intentions and want to move towards equitable relations through these partnerships.
But forming them is not enough; higher income countries should constantly consult with and learn about the practices of the countries with which they work in order to make these relationships productive for both members. As soon as one considers global interactions, culture becomes a tremendous factor. Learning about the culture of other nations and working with it instead of viewing it as a barrier obviously requires more effort and time, but will help nations decide if the expertise and tools they have are the ones they should be using. We must not impose the practices of one nation upon another just because those practices happen to work in the cultural context of the former. By admitting that we do not necessarily have the best, or the only solutions, and by framing solutions in the context and culture of the nation we are trying to help, we allow for more ideas and, thus, potential solutions to a problem. Pursued in that way, global health can become a much more effective and equitable field for all nations involved.
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[1] Koplan et al. “Towards a common definition of global health.”
[2] Dyar, Oliver-James. “What is Global Health?”
[3] Crane, Joanna. “Unequal ‘Partners,’” pp. 87
[4] Crane, Joanna. “Unequal ‘Partners,’” pp. 87
[5] Crane, Joanna. “Unequal ‘Partners,’” 87.
Yale Global Health Review 