Webinar: Justice advancement through HPSR decolonisation
By Hayley Stewart
Last week Health Systems Global’s Ethics and Justice Thematic Working Group hosted an illuminating webinar about the importance of the decolonisation of Health Policy and Systems Research. The webinar, co-hosted with The Decolonisation and Global Health Research Exchange Network (funded by The Wellcome Trust) and UNU -IIGH’s Decolonising Global Health programme (launching in August), was a forum to share ideas and actions that can be taken towards the decolonisation of HPSR, as well as looking at the challenges and opportunities that may arise during this work. Watch a recording of the full webinar.
The first speaker, Dr Caesar Atuire, spoke about the key concepts of decolonisation using the mangrove as a metaphor – likening the difficulty of decolonisation to that of uprooting the hardy mangrove tree, with its deep, widely spread roots. Dr Atuire described the key problem of colonialism as the “subtraction and substitution of people’s self-determining agency”, where the agency of those colonized is removed in the service of the interests of other people (the colonisers).
Describing the legacy of the colonial era, Dr Atuire explained that an almost covert coloniality has taken the place of colonialism, with post-colonial countries continuing to build on and within the model that was instituted by the colonials. He went on to explain key concepts of coloniality as displayed in health policy and systems research –
Epistemicide refers to the destruction of existing knowledge from sources not considered able to generate knowledge. It prevents other sources of knowledge from flourishing or becoming ‘official’ unless they conform to a Western model.
Ecocide refers to the exploitation of former colonised territories to extract resources which are given value elsewhere. Citing examples of gold mining in South Africa and Ghana, Dr Atuire described how these industries have a negative impact on people’s health and the environment, all the while making other people extremely wealthy.
Genocide, described by Dr Atuire in the context of health, says that some lives matter more than others. Siting a recent example, monkey pox has been found in West and Central Africa since the 1970s. When it appeared in Europe it suddenly became an ‘international emergency’. This shows that health research and priorities are not determined by need, but by the need of who.
Dr Atuire finished his presentation by outlining the importance of de-imperialisation. Frequently those coming from previously colonial countries feel they have a duty to “save the world”. They also believe that they hold all the solutions. But there is a need for them to rethink their frameworks, and open up to knowledge that has long been silenced. By taking a pluralistic view, together we might find new and different ways to look at the world from other angles.
Prof David McCoy of the United Nations University International Institute for Global Health (UNU-IIGH) focused the beginning of his presentation on defining contemporary colonialism and outlining how new structures of colonialism (particularly from 1980 onwards) transcend the traditional ideas of colonialism being something done by a nation state, or as something that is rooted in racial differences. He urged the need to look beyond hierarchies in terms of nation states and race. Citing research by Oxfam, Prof McCoy explained how the 62 richest people own the same amount of wealth as the 3.6 billion poorest people, while the world’s richest 20 billionaires are worth more than the entire GDP of sub Saharan Africa. This highlights how the extraction of wealth and resources does not benefit certain populations so much as it benefits a handful of wealthy individuals – many who live across the world.
So, Prof McCoy asked, what should anti-colonial work look like today? While continuing to address the unequal status of different countries and the contributions racism makes, McCoy urged we should also look at the role played by transnational organizations and private wealth actors. This wide scale extraction of wealth by a small global elite from the rest of humanity has become increasingly rampant. The desire of this minority to continue to hoard that wealth and maintain their privilege and power has also resulted in considerable impacts on our democracy and our media. These actors also exacerbate and create social divides and conflict as a means of maintaining their own privilege. So being anti-colonial today also means building social solidarities across national boundaries, and across racial, religious and cultural divides.
Citizens need to hold national governments to account, ensuring they break up monopolies, and stamp out illicit financial flows and tax avoidance. McCoy also argued that we need to challenge the ideas and narratives that sustain contemporary colonialism, including the economic myths about the social benefits of unregulated free markets and competition, and the idea that only economic growth can challenge poverty.
Prof McCoy spoke about the upcoming launch of the UNU -IIGH new ‘Decolonising Global Health’ programme, taking place in August, looking specifically at colonialism and coloniality within global health. It will focus on who dominates global health agendas, who shapes global health priorities and who has colonized this space. There will be a particular attention paid to the way the global health system interacts with the wider political economy, as well as how COVID-19 aggravated global inequalities, and how pharmaceutical industry might be better governed.
Participants then heard from Dr Bridget Pratt of Australian Catholic University, who spoke about confronting the crisis in knowledge production through a social justice lens. Dr Pratt has been developing guidance around how global health research can be structured or designed to generate new knowledge towards equity. She is currently developing a multidimensional social justice lens that integrates understandings of social justice and decolonization from the Global North alongside those from the Global South. While social justice theory in the North perhaps places more emphasis on wellbeing and inclusion, theory from the South places greater focus on harmony, recognition and power.
Dr Pratt has applied the multidimensional lens to the global health research context. She discussed the importance of reducing unfair power dynamics in the research design and funding process, particularly related to subordination, coloniality and exploitation. It is key that we build awareness that these unfair power relations exist, and work to address them by shifting control and benefits in global health research.
As possible strategies to help reduce unfair power dynamics in global health research, Dr Pratt suggested there could be reflexive discussions around power dynamics within collaboration, a more equitable number of researchers from low-income settings involved in the planning and designing of research projects, and revising global health degree program’s content to ensure the field’s colonial origins and ongoing inherent coloniality is highlighted.
Next Benilda Batzinm, Executive Director of the Center for the Study of Health System Equity and Governance (CEGSS), spoke about how rural indigenous communities in Guatemala are working to decolonise HPSR. The importance of decolonisation, she said, is to empower indigenous communities, address historic exclusion and racism. She highlighted that health systems and health are important resources for positive outcomes for indigenous communities, and so urging indigenous communities to become active in demanding accountability and rights is paramount. CEGSS is doing this through Action Research, by building the capacity of communities, building solidarity and encouraging citizens to lead by example. Batzinm said, “Most communities didn’t know that health was a right, and their participation was pivotal to bring change. We are educating communities about this.”
Batzinm said that theoretical knowledge is important, but we need to employ a blend of knowledge and experience. Knowledge gained through practice allows for credibility and trust. Southern countries get bombarded with experts who have not experienced what they are brought in to advise on and therefore lack credibility. CEGSS works to produce knowledge with communities, employing story telling through videos, audio and testimonials. To further this work, Batzinm said indigenous professionals, like her and her colleagues, need solidarity and support from an alliance of academics and researchers who truly want to decolonize both development aid and health research.
During a question and answer session, Prof Seye Abimbola from the School of Public Health at the University of Sydney, acknowledged the concern among some in HPSR that these discussions about decolonisation may cause harm, and that we need to know how to listen and respond to these concerns. Dr Abimbola spoke of how concerns are often made about progressive change, and these were outlined in the book The Rhetoric of Reaction by Albert O. Hirschman. The sorts of concerns raised can be divided into three categories:
Futility – “this problem is so big there is no way of solving it, why are you even trying?”
Jeopardy – “will this endanger gains we have already made / destroy what we do have?”
Perversity – “what if your action worsens the situation you set out to solve?”
India based Public Health academic Dr Manasee Mishra spoke about the importance of acknowledging that while colonialism involved extraction, some social groups in the former colonies benefitted (and continue to benefit) from the socio-cultural processes set in motion during the time. These include familiarity with international languages such as English, French and Spanish, modern education systems and other socio- cultural processes. Elites in post-colonial societies are usually drawn from such social groups. These elites dominate various spheres in post-colonial societies and international fora (including HPSR). They need to be consciously and actively engaged with in the decolonisation project.
Dr Mishra also cautioned against the danger of the decolonisation project being appropriated by forces which may not believe in the cause of advancing justice. The appeal of going back in time to a mythical golden era could attract such forces. This may conflict with the commitment to justice that the decolonisation project is inherently wedded to.
The webinar was a good grounding for the planning of the Ethics and Justice Thematic Working Group (TWG) organised session at The Seventh Global Symposium on Health Systems Research (HSR2022) to be held in Bogota, Colombia, in late October this year.
As Dr Atuire said, “We don’t have to agree on everything conceptually to work together, we just need to agree on the core ideas. We need to understand each other, then we can make a contribution to a richer and fuller world.”