Anti-Racism and Anti-Colonialism Praxis in Global Health—Reflection and Action for Practitioners in US Academic Medical Centers

Daffé, Zeinabou Niamé; Guillaume, Yodeline; Ivers, Louise C

doi:10.4269/ajtmh.21-0187

Cited by 25 publications

(29 citation statements)

References 18 publications

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“…7 8 These discussions are not limited to academia, and calls for equitable representation and influence of patients, clinicians and policymakers from LMICs in decision-making processes are similarly ongoing. [9][10][11] Global emergency medicine (GEM) is a relatively new, and rapidly growing, subspecialty bridging the fields of global health and emergency medicine (EM), which focuses on improving the science and practice of emergency care (EC) globally. [12][13][14] It encompasses a wide breadth of topics including the development of the EM specialty and EC systems in areas where such systems do not exist as well as clinical care during humanitarian emergencies.…”

Section: What This Study Addsmentioning

confidence: 99%

“…Previous evaluations of authorship equity within the general global health literature have shown under-representation of LMIC authors and a predominance of authors affiliated with HIC institutions 7 8. These discussions are not limited to academia, and calls for equitable representation and influence of patients, clinicians and policymakers from LMICs in decision-making processes are similarly ongoing 9–11…”

Section: Introductionmentioning

confidence: 99%

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Authorship representation in global emergency medicine: a bibliometric analysis from 2016 to 2020

et al. 2022

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IntroductionHigh-income country (HIC) authors are disproportionately represented in authorship bylines compared with those affiliated with low and middle-income countries (LMICs) in global health research. An assessment of authorship representation in the global emergency medicine (GEM) literature is lacking but may inform equitable academic collaborations in this relatively new field.MethodsWe conducted a bibliometric analysis of original research articles reporting studies conducted in LMICs from the annual GEM Literature Review from 2016 to 2020. Data extracted included study topic, journal, study country(s) and region, country income classification, author order, country(s) of authors’ affiliations and funding sources. We compared the proportion of authors affiliated with each income bracket using Χ2 analysis. We conducted logistic regression to identify factors associated with first or last authorship affiliated with the study country.ResultsThere were 14 113 authors in 1751 articles. Nearly half (45.5%) of the articles reported work conducted in lower middle-income countries (MICs), 23.6% in upper MICs, 22.5% in low-income countries (LICs). Authors affiliated with HICs were most represented (40.7%); 26.4% were affiliated with lower MICs, 17.4% with upper MICs, 10.3% with LICs and 5.1% with mixed affiliations. Among single-country studies, those without any local authors (8.7%) were most common among those conducted in LICs (14.4%). Only 31.0% of first authors and 21.3% of last authors were affiliated with LIC study countries. Studies in upper MICs (adjusted OR (aOR) 3.6, 95% CI 2.46 to 5.26) and those funded by the study country (aOR 2.94, 95% CI 2.05 to 4.20) had greater odds of having a local first author.ConclusionsThere were significant disparities in authorship representation. Authors affiliated with HICs more commonly occupied the most prominent authorship positions. Recognising and addressing power imbalances in international, collaborative emergency medicine (EM) research is warranted. Innovative methods are needed to increase funding opportunities and other support for EM researchers in LMICs, particularly in LICs.

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Section: What This Study Addsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Authorship representation in global emergency medicine: a bibliometric analysis from 2016 to 2020

et al. 2022

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“…2,4 In line with growing awareness of the colonial legacy of racism in global health, institutions need a multifaceted approach to forego the principles of cultural hierarchy that underlie the skewed influence of those from the "global North" on their partners in the "global South." 5 We believe that the anti-racist initiative at ISMMS can constructively inform the creation of institutions that promote a bright and transformative future for the field of global health. Since global health is a discipline focused on problems that are global in scope, 6 global health practices based on multidimensional and multiphase initiatives centering on global health practitioners themselves may result in institution-wide, and perhaps discipline-wide, progress towards a reimagined field that is, indeed, inclusive and anti-racist…”

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confidence: 97%

Anti-racist Medical Education in the Transformation of Global Health

Asfaw

Barthélemy

2022

Trop Doct

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The authors highlight the seldom-discussed history of racism in global health and its preceding fieldstropical health and international health. Moreover, they call for institutions to delineate a path towards an inclusive and anti-racist engagement in global health agendas. We concur with the authors' argument that an anti-racist medical education is essential for dismantling structural racism in global health.In this vein, we want to highlight the report by Hess et al. as one useful template for anti-racist global health curricula. 2 The report chronicles how the Icahn School of Medicine at Mount Sinai (ISMMS) implemented strategies to address racism and bias within every sphere of medical education. The authors mentioned that ISMMS responded to medical student advocacy against racism by establishing the institution-wide Racism and Bias Initiative (RBI), which focused on recognizing the historical foundations of racism and bias in medicine and implementing comprehensive strategies that address racism in medical education. Instead of adopting strategies that are assessed based on finite endpoints, the RBI proposed an evolving model designed for continuous transformation, which here refers to a profound revamping of frames of reference that constitute the ways in which one thinks and acts on certain subjects. 3 The RBI was led by a guiding coalition of individuals from different parts of ISMMS's ecosystem devoted to a multiphase change management process focusing on people rather than the institutional component of change. 2 The rationale for such an approach was that overlooking the individual sphere of transformation resulted in failed initiatives since the people who adopt institutional changes must themselves transform if they are to be successful in effecting a lasting transformation of their institutions. 2,4 In line with growing awareness of the colonial legacy of racism in global health, institutions need a multifaceted approach to forego the principles of cultural hierarchy that underlie the skewed influence of those from the "global North" on their partners in the "global South." 5 We believe that the anti-racist initiative at ISMMS can constructively inform the creation of institutions that promote a bright and transformative future for the field of global health. Since global health is a discipline focused on problems that are global in scope, 6 global health practices based on multidimensional and multiphase initiatives centering on global health practitioners themselves may result in institution-wide, and perhaps discipline-wide, progress towards a reimagined field that is, indeed, inclusive and anti-racist

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“…This discomfort makes it difficult for non-Indigenous peoples to conceptualize healthy Indigenous Nations thriving on this land prior to the founding of the U.S., leading to a lack of understanding of the true toll of colonization on our Nations and the factors that make us healthy outside of colonial frameworks. Without the context of Indigenous Nationhood prior to colonization, the field of global health will fail to work with us in meaningful ways, just as they would for other countries that endured colonization [12].…”

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confidence: 99%

The “Elephants in the Room” in U.S. global health: Indigenous nations and white settler colonialism

Lopez-Carmen

2022

PLOS Glob Public Health

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We are two Indigenous young people from the Oceti Sakowin, made up of the Lakota and Dakota Tribal Nations in modern day U.S. and Canada. As Indigenous health professionals and students, we are used to having to advocate for visibility in healthcare. In medical schools, students learn little of us and there are few to no Indigenous faculty [1]. In the academic literature, we are often left out of studies, creating a cycle of data inequity [2]. And in global health, Indigenous Nations are seldom considered, even in decolonizing global health spaces.Earlier this year, we realized just how rooted our invisibility in global health is when we found ourselves unsuccessfully attempting to convince three white U.S. global health physicians to center and include Indigenous Peoples in a decolonizing global health paper. Instead, we were told to make a separate paper on "Indigenous issues." When we asked the physicians to join us on the separate paper, we were told the paper would be more powerful coming from Indigenous authors alone, even after explaining the potential power of white allies joining Indigenous academics on papers that challenge the status-quo. After being siloed from the mainstream conversation on decolonizing global health, we felt this experience was a microcosm of larger systemic erasure of Indigenous Nations and white settler colonialism in U.S. global health and the decolonizing global health space.When most U.S physicians consider the term "global health" or even the term "decolonizing global health," they think of low-and middle-income countries (LMIC) outside their borders, usually in the global south. While countries outside U.S. borders should absolutely be included, rarely are the over 567 Indigenous Nations within U.S. borders considered, each with their own cultures, languages, spiritualities, and political systems predating colonization by thousands of years. In the field of U.S. global health and the decolonizing global health movement, Indigenous Nations and settler colonialism in the U.S. remain the elephants in the room.From our perspective, Indigenous erasure in global health is due to the lack of recognition of our status as sovereign Nations within a high-income country that colonized us, creating massive health disparities and social determinant of health measures on par with low-and middle-income countries (LMIC) in the global south [3]. Over the past 500 years, colonization weakened Indigenous systems that helped to maintain community health (e.g. traditional food systems, access to clean water, Indigenous languages, access to land) and replaced them with unsupported and underfunded systems, leading to disproportionate systemic health disparities, including some of the highest rates of diabetes, suicide, and cardiovascular diseases [4,5].

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Anti-Racism and Anti-Colonialism Praxis in Global Health—Reflection and Action for Practitioners in US Academic Medical Centers

Cited by 25 publications

References 18 publications

Authorship representation in global emergency medicine: a bibliometric analysis from 2016 to 2020

Authorship representation in global emergency medicine: a bibliometric analysis from 2016 to 2020

Anti-racist Medical Education in the Transformation of Global Health

The “Elephants in the Room” in U.S. global health: Indigenous nations and white settler colonialism

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