Addressing power asymmetries in global health: Imperatives in the wake of the COVID-19 pandemic

Abstract

Seye Abimbola and co-authors argue for a transformation in global health research and practice in the post-COVID-19 world.

Global vaccine equity demands reparative justice — not charity

“…These steps can mark the start of a reparative justice movement in global health that demands we confront and overturn colonial legacies that continue to devastate the health of low- and middle-income countries. 34 A commitment to funding vaccine justice in the face of the COVID-19 pandemic can be a first step in this direction.…”

How modelling can help steer the course set by the World Health Organization 2021-2030 roadmap on neglected tropical diseases

“…These will, in turn, overcome the continuous challenges of data quality and access, and the consequent model assumptions required. As programme and disease management move towards a country-ownership framework under the new roadmap, it will be key that modelling follows suit, overcoming systematic notions of knowledge ownership and challenging associated power dynamics [110][111][112] . In this way, future modelling will work to support this new NTD landscape.…”

Dialogical reflexivity towards collective action to transform global health

“…Therefore, we do not wish to propose reflexivity as the singular approach to ‘decolonise the mind’. 3 Indigenous practices of ‘knowing, being, and doing’ can enrich our understanding of reflexivity by bringing in the dimensions of relations and action. For example, Pidgeon 25 has proposed a ‘wholistic’ framework that emphasises the indigenous worldview of seeing the whole person (physical, emotional, spiritual and intellectual) in relationship with other individuals, communities, nations and the world, guided by the values of respect, reciprocity, relevance and responsibility.…”

“…Dialogical reflexivity with peers can provide the signposts towards meaningful action to decolonise both internally as individuals and structurally in the global health architecture. It is precisely the practice of reflexive dialogues with peers who critically engage with one another and demand accountability from one another 3 that can serve as our shield from the danger of being neocolonial 32 despite best intentions, or of falling into the trap of performative allyship. 33 Finally, although our focus on reflexivity has emphasised the role of individuals, we do not in any way diminish the need for more political changes at the systems and structural levels.…”

“… 1 There have been calls globally not just to build back better but to do so in a way that dismantles structural inequities. 2 Abimbola et al 3 have outlined facets of supremacy, encompassing coloniality, patriarchy, racism, white supremacy and saviourism, that together maintain power asymmetries and privilege within global health. The push-back against these inequities is perhaps most visible in the many calls to ‘decolonise global health’.…”