DECOLONIZING GLOBAL HEALTH FOR BETTER POPULATION HEALTH

on Tuesday, 15 November 2022.

Dear Colleagues,

The concept and discussion on OUR post-colonial relations are important for population health outcomes and deserve our attention. Here are my thoughts. What are yours?

During the AFREhealth conference held in Harare, Zimbabwe last August 2022 there were some presentations on the topic of decolonization of global health which were followed by vigorous discussions. I have since taken more interest in this subject and have been surprised to find that the subject of globalization is huge with many websites addressing diverse aspects of the subject including a group focusing on decolonizing contraception!
There are a number of highly regarded schools of public health and other institutions that are introducing new programs for students under Schools of Decolonizing Global Health and awarding Masters of Public Health degrees in Decolonizing Global Health.

So, what is decolonization with respect to global health? Decolonization of global health is variously defined as a movement that fights against entrenched systems of dominance and power imbalance in the work to improve the health of populations. This power imbalance may take place between countries, and institutions, in commerce and trade in health commodities and in the policy dialogue arena. Generally, the imbalance and inequity are between previously colonized regions on the one hand and the successors of the colonizer countries and regions on the other hand. It is between the governments and institutions and individuals in the global north and the global south or the so-called rich and poor countries. At the individual level, relics of our colonial history have left behind overt and covert ingrained perceptions and attitudes of superiority that result in behavior that patronizes colleagues and institutions based on which region we originate from. The net result is that a small outsider elite gets to determine what health interventions get implemented in what context, what resources go to whom, and, in short, who lives and who dies.

CLIMATE CHANGE IS HERE; PLEASE ACT NOW

on Wednesday, 24 August 2022.

Dear Colleagues,

Awareness among ordinary people on the threat of climate change is low and I am concerned.

The impact of Climate change in the daily lives of the people round the world has been very visible in the news. We have seen graphic pictures of starving children, and dying animals from drought and food shortage. We have seen wild fires destroy homes and disrupt livelihoods and we have seen pictures of floods destroying homes and disrupting livelihoods of communities and there are reports of rising sea levels threatening to wipe out small island nations.

There are epidemics of malaria and other diseases attributed to climate change and pandemics such as Covid-19 are expected to increase in frequency as a consequence of climate change. Yes, we have been informed about how the Antarctic ice sheet is melting and separating.

At personal level, I have a farm where I grow entirely rain-fed crops. The rains have frequently failed in recent years resulting in food crop failure and I have lost money in the process. Worse still, the local the population are chronically short of food.

My major concern is that while Climate change is the single biggest threat facing humanity, I do not see a matching effort to inform and educate African populations actively about this very serious threat to them. The African people know that the rains are irregular but they do not know why and how to respond.

LET US FOCUS ON WOMEN'S HEALTH

on Tuesday, 08 February 2022.

Dear All,

Lets us discuss the health of women, who are our mothers, sisters, and colleagues.

Women and men are inseparable partners in ensuring the continuity of humanity. Women as mothers have unique roles from conception, pregnancy, and childbirth. They are the pillars of families providing helpless newly-born children with critical nutrition and support. Women also provide men and children with homes where the characters and values of people are shaped and communities are built. It is evident that giving priority to the health of women must take center stage in all societies and health systems.
Reproductive health is defined by WHO as “a responsible, satisfying, and safe sex life with the capability to reproduce and the freedom to decide if, when, and how often to do so”. There are health risks at every stage of the cascade in this definition which call for support from the health system and society. These risks include infections, fistula, infertility, and unwanted pregnancies with related mental health implications that impact women’s wellbeing and power dynamics in society.

Women also have cancers and tumors affecting the uterus and cervix, ovaries, and breast, and aging in women comes with post-menopausal disorders and decalcified fragile bones.

Sub-Saharan Africa (SSA) made significant progress during the MDG period with women’s health indices when maternal mortality (MMR) and morbidity declined by 45%. However, this still leaves Africa far behind other regions of the world. The current MMR figures for SSA average 1000 deaths per 100,000 births compared with 25/100,000 in other regions; is a matter of concern and shame.

PROMOTING SOUTH-SOUTH COOPERATION IN THE CONTEXT OF COVID 19 CRISIS

on Saturday, 13 November 2021.

Dear Colleagues,

Here is a blog written for us by Dr. Patrick Kadama; Director Health Policy and Strategy at ACHEST.

"building back better for more resilient health systems in Africa and the Global South".

The impact of the COVID-19 Pandemic emerged in different ways across the globe. It directly caused devastation through unprecedented morbidity and mortality in the North but, its effects in the South, were deeply felt largely due, to weak health systems, gaps in social safety nets, scarce resources, and other factors of weak social and economic institutions. This divide distorted the global response to the pandemic. Major gaps exposed include the lack of international solidarity and sharing, including not only reluctance to share pathogen data and epidemiological information, but also resources, technology and tools, such as vaccines. This is contrary to the Nagoya Protocol for example. There has been disregard of the International Health Regulations and the WHO Code, resulting in recruitment of Health Professionals from the South to plug staffing gaps for managing the pandemic in the North. A North-South divergence in the fight against the COVID-19 crisis has emerged.

This has unmasked a fact that at present, “Global Health” practice, perpetuates the very power imbalances it claim to rectify, through colonial and extractive attitudes, and policies and practices that concentrate resources, expertise, data and branding within institutions of the Global North. These colonial attributes of global health, place Africa at a great disadvantage for gainful participation in the governance power dynamics which are shaping health policies and responses. This has brought to the fore, gaps and structural asymmetry underlying the power imbalances in the vertically structured global health practice between the North and the South. A contextualized consideration of the Africa region is required to meet challenges relating to this spill-over of a colonial supremacy mindset, of the vertical North to South Global Health construct.

COVID-19 IS AN OPPORTUNITY TO RETHINK AFRICAN HEALTH SYSTEMS

on Monday, 23 August 2021.

Dear Colleagues,

Here is a discussion we should all have at this challenging time.

Human history is characterized by transformations that follow major upheavals and challenges. Examples include the creation of the League of Nations in 1920 and the UN system in 1945 that followed the World Wars 1 and 2 respectively. Others are the establishment of the African Centers for Disease Control after the Ebola outbreak in West Africa in 2016. In Uganda, HIV led to the creation of the multisectoral Uganda Aids Commission; copied by other countries. COVID-19 pandemic is a major global upheaval that must trigger major transformations globally and in individual countries. There is evidence that the frequency of pandemics will increase and our preparedness and response is central to human survival. Louis Pasteur frightfully stated “Gentlemen, it is the microbes who will have the last word”. So how do we delay this?

Each country and the world should take stock of the experience of COVID-19 and apply lessons learnt to design future strategies. Globally, this is already happening; there is a WHO Panel studying COVID 19 origins, the UN General Assembly will convene to adopt a Pandemic Treaty and the June 2021 World Health Summit adopted the Kampala Declaration. A Scientific Advisory Group for the Origins of Novel Pathogens is being created by WHO for the One Health approach. What should African countries do?

African countries have learnt many lessons from COVID-19; among the most prominent are that disease outbreaks can bring a country to a standstill and that public health cannot be left to the market. Governments have a key role in ensuring that there are effective multisectoral systems in place for disease outbreak preparedness and response. Africa has also painfully learnt that capacity is lacking in the continent to manufacture essential technologies to control pandemics and that in this crisis, African countries are shamefully the last to access these essential technologies. Investing in health systems and the health economy must therefore become a top priority as a matter of life and death. The pathogen economy calls for the African disease burden to be reflected in the African economies; instead of being a source of wealth for other countries as is the case now.