Read on Twitter
Thread on racism in #tuberculosis & global health.
I have been writing about power imbalance in global health.
Every aspect of global health is dominated by individuals, institutions and funders in HICs. Global health is neither global nor diverse. https://www.forbes.com/sites/madhukarpai/2020/03/08/global-health-needs-to-be-global--diverse/#28936f0c7659
I have been writing about power imbalance in global health.
Every aspect of global health is dominated by individuals, institutions and funders in HICs. Global health is neither global nor diverse. https://www.forbes.com/sites/madhukarpai/2020/03/08/global-health-needs-to-be-global--diverse/#28936f0c7659
This NYT piece by @apoorva_nyc brought this discussion home to my own field of tuberculosis. It hits me hard because I know the people, and I served on the Board of @StopTB. I care about the agency & have given my time/expertise. https://www.nytimes.com/2020/09/12/health/ditiu-stoptb-united-nations.html
I respect the Board's independent investigation and look forward to the findings.
Whatever the outcome, it is critical to use this moment to reflect on the structural issues that make tuberculosis problematic. Otherwise, nothing will change.
Whatever the outcome, it is critical to use this moment to reflect on the structural issues that make tuberculosis problematic. Otherwise, nothing will change.
First, tuberculosis has a very old colonial, exploitative history. This article by Paula Akugizibwe is powerful and worth reading: https://howwegettonext.com/the-exploitative-history-of-one-of-the-worlds-deadliest-diseases-925fcef89071
Second, although TB did kill millions in Europe and North America, the disease today mostly affects Black, Indigenous and People of Color (BIPOC) people in low and middle-income countries. In Canada, it primarily affects Indigenous communities where the incidence is 300X higher.
Although TB mostly affects BIPOC folks, the agenda today is still set by agencies and individuals in high-income countries, and mostly led by White folks from privileged backgrounds. I am aware that I am privileged, working on TB in a Center located in Canada.
Who controls TB funding & who has influence?
USAID, Global Fund, BMGF, Unitaid, DFID, Global Affairs Canada, etc (all led by White folks in HICs)
Yes, TB affected countries do spend money, but donors have a huge influence on the global agenda.
USAID, Global Fund, BMGF, Unitaid, DFID, Global Affairs Canada, etc (all led by White folks in HICs)
Yes, TB affected countries do spend money, but donors have a huge influence on the global agenda.
Where are major TB agencies headquartered & who leads them?
WHO, Stop TB, USAID, Global Fund, FIND, Aeras/IAVI, TB Alliance, Unitaid, Union, KNCV, BMGF,
All are based in HICs, all led by white folks.
WHO, Stop TB, USAID, Global Fund, FIND, Aeras/IAVI, TB Alliance, Unitaid, Union, KNCV, BMGF,
All are based in HICs, all led by white folks.
Who dominates tuberculosis research productivity?
Our own bibliometric analysis shows that America dominates TB research (despite the low incidence). USA is also the biggest funder of TB researcher and R&D. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199706
Our own bibliometric analysis shows that America dominates TB research (despite the low incidence). USA is also the biggest funder of TB researcher and R&D. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199706
Where are big decisions made about TB?
Geneva, Washington DC, London, Seattle, NYC
Geneva, Washington DC, London, Seattle, NYC
So, this is why TB, like all of global health, is structurally problematic. Even well-intentioned people cannot overcome this deep power imbalance.
So, at some level, it is not surprising that TB has been included in a long and growing list of agencies which have structural racism and lack of diversity:
UNAIDS, UN, MSF, Women Deliver, USAID, Planned Parenthood, London School, IWHC, etc.
UNAIDS, UN, MSF, Women Deliver, USAID, Planned Parenthood, London School, IWHC, etc.
The structural issues have been bothering me for some years. In 2018, I wrote this piece @PLOSMedicine
Time for high-burden countries to lead the tuberculosis research agenda https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002544
Time for high-burden countries to lead the tuberculosis research agenda https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002544
I had written: The world cannot depend on a few wealthy countries with very low TB incidence to support all the research that is required to tackle TB. High-burden, middle-income countries with high TB rates must step up.
What we see in TB, we see in every global health organization & international aid agency.
-BIPOC folks are not in leadership roles
-Decisions are made far away from where the problems are
-Funding is tightly controlled by groups in HICs
-HIC researchers dominate
-BIPOC folks are not in leadership roles
-Decisions are made far away from where the problems are
-Funding is tightly controlled by groups in HICs
-HIC researchers dominate
All of this creates toxic work environments and incredible levels of stress in global health and aid agencies.
My piece on burnout in global health digs deeper: https://www.forbes.com/sites/madhukarpai/2020/07/20/burnout-a-silent-crisis-in-global-health/#3242a49d4df8
My piece on burnout in global health digs deeper: https://www.forbes.com/sites/madhukarpai/2020/07/20/burnout-a-silent-crisis-in-global-health/#3242a49d4df8
Since global health leadership is dominated by White men from HICs, it cannot be easy for women and BIPOC. Concerns about sexual harassment, racism, White supremacy and abuse of power have been raised in many settings.
Here are some recent articles on this:
Here are some recent articles on this:
White Supremacy in Global Health by @AnuKumarIpas https://www.thinkglobalhealth.org/article/white-supremacy-global-health
Silenced Voices in Global Health @KatriBertram @udnore https://www.thinkglobalhealth.org/article/silenced-voices-global-health
From Dependency to Decolonization in Global Health by Paula Akugizibwe: https://republic.com.ng/august-september-2020/purse-strings-attached/
We must translate anti-racism statements into action by Dorothy Peprah: https://www.devex.com/news/opinion-we-must-translate-anti-racism-statements-into-action-97591
Let’s equalise our antiracist language by @Dr2NisreenAlwan https://blogs.bmj.com/bmj/2020/07/03/nisreen-alwan-lets-equalise-our-antiracist-language/
Real Talk on Racism in the Global Health Sector by @globalgamechngr https://globalhealth.org/letter-from-loyce-real-talk-on-racism-in-the-global-health-sector/
How Gender Parity Improves Global Health by @DrTedros @DrSenait https://www.project-syndicate.org/commentary/gender-parity-improves-global-health-by-tedros-adhanom-ghebreyesus-and-senait-fisseha-2019-03?barrier=accesspaylog
Challenging international development to get out of its comfort zone on gender equality by Rachel Firth & @RoopaDhatt https://www.devex.com/news/opinion-challenging-international-development-to-get-out-of-its-comfort-zone-on-gender-equality-96687
It is not enough to be quietly anti-racist by @ColleenDaniels8 https://medium.com/@colleen.daniels/it-is-not-enough-to-be-quietly-anti-racist-5d7380b6dcb8
Can schools of global public health dismantle colonial legacies? @DrMishalK @udnore & Dorothy Peprah https://www.nature.com/articles/s41591-020-1062-6
On equity in the international development sector — we need more intravists, by @BlessingOmakwu https://www.devex.com/news/opinion-on-equity-in-the-international-development-sector-we-need-more-intravists-97404
How to be Anti-Racist in Aid
@StephKimou @romainmurphy & @communityheal10 https://medium.com/aidreimagined/video-how-to-be-anti-racist-in-aid-a6eaebc54d3e
@StephKimou @romainmurphy & @communityheal10 https://medium.com/aidreimagined/video-how-to-be-anti-racist-in-aid-a6eaebc54d3e
It’s time to put an end to supremacy language in international development by Ann Hendrix-Jenkins https://www.opendemocracy.net/en/transformation/its-time-to-put-an-end-to-supremacy-language-in-international-development/
Bearing witness inside MSF
by @arnabmajumdar_ https://www.thenewhumanitarian.org/opinion/first-person/2020/08/18/MSF-Amsterdam-aid-institutional-racism
by @arnabmajumdar_ https://www.thenewhumanitarian.org/opinion/first-person/2020/08/18/MSF-Amsterdam-aid-institutional-racism
Each of us approaches the above issues through our own lens:
- Some of us are advocating for women in global health
- Some of us are advocating for LMIC representation
- Others focus on racism against BIPOC
- Others point our White supremacy
- Some focus on improving diversity
- Some of us are advocating for women in global health
- Some of us are advocating for LMIC representation
- Others focus on racism against BIPOC
- Others point our White supremacy
- Some focus on improving diversity
- Some of us are focused on "decolonizing global health"
- Some focus on neoliberalism
- Some on the White gaze
They are all connected and result in the inequities we see.
We are trying to touch/fix different parts of the same elephant.
- Some focus on neoliberalism
- Some on the White gaze
They are all connected and result in the inequities we see.
We are trying to touch/fix different parts of the same elephant.
