Decolonizing Global Health and the Impact of Colonialism on Healthcare

Summary

In this episode of Clinical Problem Solvers: Anti-Racism in Medicine, we are joined by Michelle Morse, MD, MPH, Deputy Commissioner for the Center for Health Equity and Community Wellness (CHECW) and the inaugural Chief Medical Officer at the NYC Department of Health and Mental Hygiene (NYCDOHMH), and Paul Farmer, MD, PhD, Kolokotrones University Professor of Global Health and Social Medicine at Harvard University. Together, we discuss what global health equity looks like in the age of COVID-19.

Learning Objectives

After listening to this episode listeners will be able to…

1. Recognize that  global health equity and global vaccine equity are everyone’s responsibility 
2. Understand what decolonizing global health really means 
3. Appreciate the importance of solidarity and human interconnectedness 

Credits

• Written and produced by: Dereck Paul, MS, Chioma Onuoha, Utibe R. Essien, MD, MPH, Rohan Khazanchi, LaShyra Nolen, Naomi Fields, Michelle Ogunwole, MD, Jazzmin Williams, and Jennifer Tsai MD, M.Ed
• Hosts: Utibe Essien, MD, MPH, Dereck Paul, MS, Chioma Onuoha
• Infographic: Creative Edge Design
• Show Notes: Chioma Onuoha
• Guests: Michelle Morse, MD, MPH (@michellemorse) and Paul Farmer, MD, PhD

Timestamps

00:00    Introductions

04:00 What Brought You to Global Health Work?

11:50    Why is Global Health Equity Everyone’s Problem?

23:40   How has COVID-19 Changed Global Health Work and Perspectives? 

40:30  The Role of Identity in Global Anti-Racism Work

49:00   Decolonize Global Health Movement

1:02:49 Hope for the Future 

Takeaways

1. The Global COVID-19  Response Must Be Anti-Racist 

An anti-racist COVID-19 response means that quality care, quality vaccines, and quality public health information must be provieded to all. From social distancing to contact tracing to vaccin distribution, every step should be considered through an anti-raicst framework. This includes financing vaccine acquisition for all countries and avoiding the global north vaccine hoarding that is happening today. It is important that we avoid vaccine tunnel vision and recognize the broader social context and need for social support systems worldwide. 

2. The Four S’s  

As Dr. Paul Farmer often says, an effective infectious disease global health response requires: 

• Staff – caregivers with the knowledge and passion to address health concerns
• Stuff – the physical materials required for effective treatment or intervention 
• Space – places where people can safety receive appropriate care 
• Systems – policies and institutional systems that facilitate needed health responses

3. Why should everyone care about global vaccine equity?

“Unless everyone is safe, no one is” – Dr. Paul Farmer

The world is incredibly interconnected and, as COVID-19 has shown, we have to recognize the idea of collective survival. Health and well being is a global endeavor and an interdependent fight. Furthermore, we must reclaim the heart and soul of medicine: caretaking, healing, and the creative aspects of the profession that oftentimes get pushed to the side. American physicians and health professionals have immense power and a duty to use that power for the greater good to interrupt, and interrogate the colonial and imperial practices perpetrated by our own government. We must hold our government accountable. At the heart of this is a need for global solidarity. 

Pearls 

The Importance of this Moment 

Both of our guests highlighted the HIV/AIDS movement as a catalyst for their continuing passion for global health equity. The COVID-19 pandemic provides a similar opportunity today for us to scale up our critical consciousness and re-examine the functioning of our society. People are naming racism, settler colonialism, and imperialism more than ever. In this current moment we can build on that momentum, shift perspectives and work towards long lasting equitable and anti-racist change.

Dangers of American Exceptionalism 

It is imperative that we look beyond the walls of our nation and the privileges that living in the United States afford us in order to recognize the danger of American exceptionalism and how it impacts people across the world. For example, currently the United States, and other wealthy countries, are hoarding COVID-19 vaccines making it difficult for other countries to vaccinate their populations. Considering the interconnectedness of our world, by preventing equitable vaccine distribution we will only lengthen the current pandemic. As a country, we must expand our global critical consciousness and strive towards global equity by financing vaccine acquisition, investing in our education systems, interrogating American privilege and more. 

Decolonizing Global Health – Allow the Global South to Lead 

Part of decolonizing global health means being willing to take a backseat when it comes to defining, researching, and executing global south health priorities. This is especially true for large outside universities and institutions that habitually fail to engage domestic stakeholders in research and health decision making processes. We must trust the communities we serve to teach us and to guide initiatives. 

References Mentioned

Additional References 

1. Farmer, P., Kim, J. Y., Kleinman, A., & Basilico, M. (2013). Reimagining global health: An introduction. Berkeley: University of California Press.
2. Farmer, P. (2020). Fevers, feuds, and diamonds: Ebola and the ravages of history. New York: Farrar, Straus and Giroux.
3. Goodwin, C. (2020, December 23). Paul Farmer on How We Tell the Story of a Pandemic. Retrieved from https://www.thenation.com/article/culture/paul-farmer-fever-feuds-interview/
4. Richardson, E. T., Malik, M. M., Darity, W. A., Mullen, A. K., Morse, M. E., Malik, M., . . . Jones, J. H. (2021). Reparations for Black American descendants of persons enslaved in the U.S. and their potential impact on SARS-CoV-2 transmission. Social Science & Medicine, 113741. doi:10.1016/j.socscimed.2021.113741

Transcript

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Disclosures

The hosts and guests report no relevant financial disclosures.

Citation

Morse M, Farmer PE, Onuoha C, Khazanchi R, Nolen L, Fields N, Ogunwole M, Tsai J, Essien UR, Paul D. “Episode 7: Anti-Racism, Global Health Equity, and the COVID-19 Response.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. April 1, 2021.