Decolonising Global (Public) Health: from Western universalism to Global pluriversalities

Affun-Adegbulu, Clara; Adegbulu, Opemiposi

doi:10.1136/bmjgh-2020-002947

Cited by 99 publications

(97 citation statements)

References 9 publications

(11 reference statements)

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“…It must also be acknowledged, however, that greater professionalization of social sciences in epidemics, in and of itself, remains only a partial response to the deep political-economic and governance challenges – both in states and donor institutions – that prevent long-term structural change. Lastly, it is important that the field engages with current debates to “decolonize global health” and ensure greater and diverse leadership by practitioners based in the global south, especially crises-prone countries [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Integrating the social sciences in epidemic preparedness and response: A strategic framework to strengthen capacities and improve Global Health security

et al. 2020

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Background The importance of integrating the social sciences in epidemic preparedness and response has become a common feature of infectious disease policy and practice debates. However to date, this integration remains inadequate, fragmented and under-funded, with limited reach and small initial investments. Based on data collected prior to the COVID-19 pandemic, in this paper we analysed the variety of knowledge, infrastructure and funding gaps that hinder the full integration of the social sciences in epidemics and present a strategic framework for addressing them. Methods Senior social scientists with expertise in public health emergencies facilitated expert deliberations, and conducted 75 key informant interviews, a consultation with 20 expert social scientists from Africa, Asia and Europe, 2 focus groups and a literature review of 128 identified high-priority peer reviewed articles. We also analysed 56 interviews from the Ebola 100 project, collected just after the West African Ebola epidemic. Analysis was conducted on gaps and recommendations. These were inductively classified according to various themes during two group prioritization exercises. The project was conducted between February and May 2019. Findings from the report were used to inform strategic prioritization of global investments in social science capacities for health emergencies. Findings Our analysis consolidated 12 knowledge and infrastructure gaps and 38 recommendations from an initial list of 600 gaps and 220 recommendations. In developing our framework, we clustered these into three areas: 1) Recommendations to improve core social science response capacities, including investments in: human resources within response agencies; the creation of social science data analysis capacities at field and global level; mechanisms for operationalizing knowledge; and a set of rapid deployment infrastructures; 2) Recommendations to strengthen applied and basic social sciences, including the need to: better define the social science agenda and core competencies; support innovative interdisciplinary science; make concerted investments in developing field ready tools and building the evidence-base; and develop codes of conduct; and 3) Recommendations for a supportive social science ecosystem, including: the essential foundational investments in institutional development; training and capacity building; awareness-raising activities with allied disciplines; and lastly, support for a community of practice. Interpretation Comprehensively integrating social science into the epidemic preparedness and response architecture demands multifaceted investments on par with allied disciplines, such as epidemiology and virology. Building core capacities and competencies should occur at multiple levels, grounded in country-led capacity building. Social science should not be a parallel system, nor should it be “siloed” into risk communication and community engagement. Rather, it should be integrated across existing systems and networks, and deploy interdisciplinary knowledge “transversally” across all preparedness and response sectors and pillars. Future work should update this framework to account for the impact of the COVID-19 pandemic on the institutional landscape.

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Section: Discussionmentioning

confidence: 99%

Integrating the social sciences in epidemic preparedness and response: A strategic framework to strengthen capacities and improve Global Health security

et al. 2020

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“…There is no doubt that our discipline needs to work much harder to address this inequality, and we acknowledge the authorship of this paper itself lacks the diversity we aspire to. An in-depth discussion is beyond the scope of this article, and we encourage readers to access and actively engage with the growing body of literature on this topic, including discussions on the role of researchers from HICs when it comes to decolonising global health [78][79][80][81].…”

Section: Discussionmentioning

confidence: 99%

Equity in clinical trials for HIV-associated cryptococcal meningitis: A systematic review of global representation and inclusion of patients and researchers

et al. 2021

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Background It is essential that clinical trial participants are representative of the population under investigation. Using HIV-associated cryptococcal meningitis (CM) as a case study, we conducted a systematic review of clinical trials to determine how inclusive and representative they were both in terms of the affected population and the involvement of local investigators. Methods We searched Medline, EMBASE, Cochrane, Africa-Wide, CINAHL Plus, and Web of Science. Data were extracted for 5 domains: study location and design, screening, participants, researchers, and funders. Data were summarised and compared over 3 time periods: pre-antiretroviral therapy (ART) (pre-2000), early ART (2000 to 2009), and established ART (post-2010) using chi-squared and chi-squared for trend. Comparisons were made with global disease burden estimates and a composite reference derived from observational studies. Results Thirty-nine trials published between 1990 and 2019 were included. Earlier studies were predominantly conducted in high-income countries (HICs) and recent studies in low- and middle-income countries (LMICs). Most recent studies occurred in high CM incidence countries, but some highly affected countries have not hosted trials. The sex and ART status of participants matched those of the general CM population. Patients with reduced consciousness and those suffering a CM relapse were underrepresented. Authorship had poor representation of women (29% of all authors), particularly as first and final authors. Compared to trials conducted in HICs, trials conducted in LMICs were more likely to include female authors (32% versus 20% p = 0.014) but less likely to have authors resident in (75% versus 100%, p < 0.001) or nationals (61% versus 93%, p < 0.001) of the trial location. Conclusions There has been a marked shift in CM trials over the course of the HIV epidemic. Trials are primarily performed in locations and populations that reflect the burden of disease, but severe and relapse cases are underrepresented. Most CM trials now take place in LMICs, but the research is primarily funded and led by individuals and institutions from HICs.

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“…The propensity for the universal in global health-often apparent in the declared aim of research papersstems partly from its biomedical and colonial origins. [7][8][9][10] To be rigorous is therefore a cliché that demands universal truths, or external validity, or a default to uniform and standardised methods, metrics, indicators, measures, around the world. But truth, in such a centralised or universal sense is typically not the goal in the quest for equity.…”

Section: Introductionmentioning

confidence: 99%

The uses of knowledge in global health

Abimbola

2021

BMJ Glob Health

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If …the problem of society is mainly one of rapid adaptation to changes in the particular circumstances of time and place… [then] the ultimate decisions must be left to the people who are familiar with these circumstances, who know directly of the relevant changes and of the resources immediately available to meet them. We cannot expect that this problem will be solved by first communicating all this knowledge to a central board which, after integrating all knowledge, issues its orders. We must solve [the problem] by some form of de-centralization… But the '[people] on the spot' cannot decide solely on the basis of [their] limited but intimate knowledge of the facts of [their] immediate surroundings. There still remains the problem of communicating to [them] such further information as [they need] to fit [their] decisions into the whole pattern of changes of the larger […] system. How much knowledge [do they] need to do so successfully? Which of the events which happen beyond the horizon of [their] immediate knowledge are of relevance to [their] immediate decision, and how much of them need [they] know? -F. A. Hayek (1899-1992) 1

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Decolonising Global (Public) Health: from Western universalism to Global pluriversalities

Cited by 99 publications

References 9 publications

Integrating the social sciences in epidemic preparedness and response: A strategic framework to strengthen capacities and improve Global Health security

Integrating the social sciences in epidemic preparedness and response: A strategic framework to strengthen capacities and improve Global Health security

Equity in clinical trials for HIV-associated cryptococcal meningitis: A systematic review of global representation and inclusion of patients and researchers

The uses of knowledge in global health

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