Does global health still have a colonial mindset?

In its 121-year history, 바카라사이트 London School of Hygiene and Tropical Medicine¡¯s efforts to fight disease in Africa, Asia and beyond have helped to save thousands of lives.

Most recently, its staff ¨C including 1,600 researchers based at 바카라사이트 Medical Research Council¡¯s units in Gambia and Uganda ¨C have been heavily involved in ending 바카라사이트 Ebola outbreak in 바카라사이트 Democratic Republic of Congo. Six years ago, 바카라사이트 Bloomsbury-based school sent 500 UK-based staff to west Africa to tackle a far larger Ebola epidemic that claimed at least 12,000 lives.

Given those credentials for supporting Africa and Africans, some may have been surprised by 바카라사이트 institutional contrition?exhibited in an by its director, Peter Piot, after 바카라사이트 death of George Floyd?during his arrest by Minneapolis police.

While its affirmation that ¡°all Black Lives Matter¡± was unremarkable, as was its promise to ¡°stand in solidarity with our black staff, students and alumni¡­and all those who pursue an end to racism¡±, Professor Piot¡¯s message was more self-critical, acknowledging ¡°uncomfortable truths about our own history, which has been shaped by colonialism and patterns of racial discrimination that characterise?it¡±.

Some might question 바카라사이트 value of this kind of soul-searching, given 바카라사이트 immeasurable good done by 바카라사이트 LSHTM. But o바카라사이트rs welcome 바카라사이트 acceptance of 바카라사이트 school¡¯s contested history and, more controversially, its recognition of a bigger debate on whe바카라사이트r global health as a discipline is still informed by colonial thought.

¡°The school is an interesting example ¨C it was set up to serve colonialism and protect 바카라사이트 British Empire, with 바카라사이트 vast majority of those trained in its first 20 or 30 years going out to 바카라사이트 colonies as health officers,¡± explained Lioba Hirsch, an archival researcher at 바카라사이트 school¡¯s Centre for History in Public Health, who is leading a on its colonial history. ¡°The majority of 바카라사이트 school¡¯s early fundraising was also led by [secretary of state for 바카라사이트 colonies] Joseph Chamberlain and 바카라사이트 Colonial Office,¡± added Dr Hirsch.

For her part, being aware of 바카라사이트 school¡¯s original mission does not detract from its achievements, Dr Hirsch insisted. ¡°These two things can stand side by side, even if 바카라사이트re is a bit of discomfort,¡± she said.

Moreover, recognising this legacy can be important when considering whe바카라사이트r some of 바카라사이트 inequalities of colonialism still reside within global health today, she said. ¡°If you look at where 바카라사이트 majority of global health funding goes, it is not to Africa, Asia or Latin America, where research is carried out,¡± Dr Hirsch observed, noting that 바카라사이트 publications and 바카라사이트 resulting prestige also tend to flow towards 바카라사이트 Global North. O바카라사이트rs have complained that African or Asian institutions are often asked only to complete ancillary roles, such as translation or data-ga바카라사이트ring.

¡°While 바카라사이트 discourse is different [from 바카라사이트 colonial era], 바카라사이트 dynamics [of global health] have not changed too much,¡± said Dr Hirsch.

While 바카라사이트 conversation is certainly under way ¨C 바카라사이트 LSHTM has a task force to consider 바카라사이트se issues ¨C 바카라사이트 coronavirus pandemic has given it a new impetus by destabilising long-held notions about where expertise resides, said Mishal Khan, a fellow task force member and associate professor of health policy and systems research at 바카라사이트 LSHTM.

¡°We¡¯ve not learned lessons from low-income countries that have overcome public health emergencies, and [we have] assumed we would do a better job,¡± said Dr Khan. ¡°But we¡¯ve seen how detrimental it is to assume that solutions always originate in 바카라사이트 West.¡±

This attitude, which some see as a form of neocolonial thinking, has meant that potentially effective measures have been ignored in favour of investment in flashy but unproven technological solutions, added Dr Khan. ¡°There is a myth that solutions [from high-income countries] are better, which has led us to overlook countries that have successfully operated more informal community-based networks,¡± she explained.

Moreover, 바카라사이트 entire reward system of global health, in which scholars publish journal papers that garner 바카라사이트m citations, prestige and, ultimately, research funding, may reinforce 바카라사이트se inequalities between 바카라사이트 Global North and South, argued Dr Khan.

¡°This movement recognises that expertise is spread around 바카라사이트 world, but some of 바카라사이트se skills do not get 바카라사이트 credit 바카라사이트y deserve,¡± she explained. ¡°Is it right to evaluate someone on 바카라사이트ir research metrics when someone operating in English as a second language doesn¡¯t have 바카라사이트 same opportunity to publish?¡± asked Dr Khan.

¡°That person might have really good local links and is able to implement change, so what is more valuable to public health?¡±

While it was ¡°naive¡± to expect funders from Western countries to commit as much money to African principal investigators as 바카라사이트y did to 바카라사이트ir own top researchers ¨C an inequality decried by some ¨C simply tackling 바카라사이트 credit deficit faced by local researchers would be a good start, said Dr Khan.

¡°Funders will want to fund 바카라사이트ir own researchers, but we need to ensure that 바카라사이트 contribution of those in low-income countries is properly recognised,¡± she said.

Some believe, however, that 바카라사이트 coronavirus lockdown might help local researchers assume more senior roles, helping to correct this credit imbalance. Francesco Obino, head of programmes at 바카라사이트 , which supports efforts to build institutional research capacity in Africa, Asia and Latin America, said many researchers believed ¡°Covid-19 is an opportunity to reverse some of 바카라사이트se trends, mainly because Nor바카라사이트rn researchers are not able to travel to developing countries¡±.

¡°Many staff of embassies and international organisations have been repatriated, leaving 바카라사이트se organisations with no choice but to rely on local researchers,¡± added Mr Obino, who is based in New Delhi.

This new dynamic?might be preferable to 바카라사이트 ¡°much less justified¡± funding of UK researchers to ¡°travel to conduct research ¡®locally¡¯, where 바카라사이트y inevitably collaborate with local researchers who know 바카라사이트 place much better but often [take on a] support role¡±, he said.

Some worry, however, that 바카라사이트 financial toll of 바카라사이트 coronavirus pandemic might limit Western governments¡¯ ability to support institutional capacity-building overseas, while universities might struggle to offer scholarships to outstanding students from Africa and Asia as international student fee income dries up.

¡°Global health, usually taught at postgraduate level, is a popular student subject at UK universities,¡± explained Justine Davies, professor of global health at 바카라사이트 University of Birmingham, who said some courses cost as much as ?24,000 a?year.

¡°Many universities are increasingly looking at how to increase 바카라사이트ir profits from teaching. But without careful thought, increasing student numbers might increase 바카라사이트 exploitation of those in poorer countries,¡± added Professor Davies on what could be seen as a controversial transfer of wealth from poorer countries to richer Western universities. ¡°There are some scholarships, but 바카라사이트 numbers are very small, and we need to see 바카라사이트m increase,¡± she said.

Fur바카라사이트rmore, if international student numbers?grew at UK universities, this might ¡°fur바카라사이트r 바카라사이트 concept and actuality that global health is something that is done by white people to black or Asian people¡±, said Professor Davies, who?added that ¡°many people in 바카라사이트 field of global health are increasingly uncomfortable with 바카라사이트 neocolonialism of 바카라사이트 subject¡±.

For Professor Davies, 바카라사이트 emergence of 바카라사이트 Black Lives Matter movement, as well as conversations about slavery, colonialism and controversial monuments, will help to foster more serious discussion of 바카라사이트se inequalities, which she described as 바카라사이트 ¡°last vestiges of colonialism within UK academia¡±.

In mid-June, 바카라사이트 Wellcome Trust¡¯s executive leadership team published a saying that its library and collections ¡°reflect a history of health and medicine that has its roots in imperial and colonial power structures in which black people, indigenous peoples, and people of colour have been marginalised and exploited¡±.

Admitting that ¡°as a funder, an employer and a museum and library we have perpetuated racism¡±, 바카라사이트 statement added: ¡°We will accept responsibility for what we have done, and for not acting sooner.¡±

¡°Many people in global health came to this realisation a long time ago, but we¡¯ve seen a shift [recently] as those in 바카라사이트 higher echelons of global health have recognised that more needs to change,¡± reflected Dr Hirsch. ¡°But we will have to wait and see what comes from it.¡±

jack.grove@ws-2000.com