Dr Tammam Aloudat تمّام العودات @Tammamo (a Syrian born, Syrian national working with Médecins Sans Frontières in Switzerland) co-authored a “roadmap” for decolonising global health. In a carol of eight tweets, he objected to my critique.
He objected to the suggestions that (i) the authorship of the “roadmap” for decolonising global health should not be situated in the global north and (ii) he and his co-authors were tone deaf for not understanding this.
Equity — fairness — is an underlying principle of global health. And yet the power within the global-health academic and practitioner space is wildly lopsided. The major sources of power lie, purely and simply, with the country in which one resides and the institutions within which one works. The authors of the roadmap for decolonising global health are all affiliated with powerful global institutions in extremely wealthy countries in the global north.
Over the past few years there has been a resurgence of interest in the power imbalance in global health, and a recognition that it has a (neo)colonial power structure. Those with power export the money and ideas — from the global north to the global south. The loose basis for arguments about decolonising global health revolve around redistributing that power: the money, the ideas, and the legitimacy. Identifying who speaks for whom is a critical part of the process of decolonising global health. This is where the authors of the roadmap and I diverge. I think it is tone deaf to sit in powerful institutions in the global north and outline how decolonisation should happen. It is tone deaf without regard to the colour of the author’s skin, their nationality, ethnic origin, or country of birth.
The geography of power dictates that if the institutions in the global north author the roadmap to decolonisation they will have retained power in the very process of redistributing power. They will “hold the whip and the chum”. The five authors (with good intention and good heart) have, quite literally, invited others to their decolonising table. That is tone deaf, and it behoves those with power to reflect on its source and consider the possibility of redistributing it — including redistributing the power of the voice. This would mean elevating the voice of others above their own. Being deeply committed to a social justice cause does not give you the legitimacy to speak on behalf of those who have been disenfranchised.
One of the ironies is, I heard one of the authors explicitly question the legitimacy of their own voice, for the very reasons that I outline in my article.
There are plenty of areas in the decolonising global health debate for people from every country to contribute. Do I want to silence the authors? No. They bring important insights to the debate and they give weight to the arguments. They just don’t have the legitimacy to draw the roadmap and send out the party invitations. Because of the geography of power, well-intentioned voices in the global north drown out softer, more urgent voices in the global south.
#decolonising #decolonising #globalhealth