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Airhihenbuwa CO, Ford C, Iwelunmor J, Griffith DM, Ameen K, Murray T, Nwaozuru U. Decolonization and antiracism: intersecting pathways to global health equity. ETHNICITY & HEALTH 2024:1-15. [PMID: 38959185 DOI: 10.1080/13557858.2024.2371429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/18/2024] [Indexed: 07/05/2024]
Abstract
In this paper, as Black scholars, we address ways that interventions designed to promote equity in health can create pathways for coupling decolonization with antiracism by drawing on the intersection of the health of Africans and African Americans. To frame this intersection, we offer the Public Health Critical Race Praxis (PHCRP) and the PEN-3 Cultural Model as antiracism and decolonization tools that can jointly advance research on colonization and racism globally. We argue that racism is a global reality; PHCRP, an antiracism framework, and PEN-3, a decolonizing framework, can guide interventions to promote equity for Africans and African Americans.
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Affiliation(s)
| | - Chandra Ford
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Juliet Iwelunmor
- Washington University School of Medicine, Washington University in St. Louis, Saint Louis, MO, USA
| | | | - Khadijah Ameen
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Teri Murray
- Trudy Busch Valentine School of Nursing, Saint Louis University, Saint Louis, MO, USA
| | - Ucheoma Nwaozuru
- School of Medicine, Wake Forest University, Winston-Salem, NC, USA
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Lebu S, Musoka L, Graham JP. Reflective questioning to guide socially just global health reform: a narrative review and expert elicitation. Int J Equity Health 2024; 23:3. [PMID: 38183120 PMCID: PMC10770991 DOI: 10.1186/s12939-023-02083-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 12/15/2023] [Indexed: 01/07/2024] Open
Abstract
Recent research has highlighted the impacts of colonialism and racism in global health, yet few studies have presented concrete steps toward addressing the problems. We conducted a narrative review to identify published evidence that documented guiding frameworks for enhancing equity and inclusion in global health research and practice (GHRP). Based on this narrative review, we developed a questionnaire with a series of reflection questions related on commonly reported challenges related to diversity, inclusion, equity, and power imbalances. To reach consensus on a set of priority questions relevant to each theme, the questionnaire was sent to a sample of 18 global health experts virtually and two rounds of iterations were conducted. Results identified eight thematic areas and 19 reflective questions that can assist global health researchers and practitioners striving to implement socially just global health reforms. Key elements identified for improving GHRP include: (1) aiming to understand the historical context and power dynamics within the areas touched by the program; (2) promoting and mobilizing local stakeholders and leadership and ensuring measures for their participation in decision-making; (3) ensuring that knowledge products are co-produced and more equitably accessible; (4) establishing a more holistic feedback and accountability system to understand needed reforms based on local perspectives; and (5) applying systems thinking to addressing challenges and encouraging approaches that can be sustained long-term. GHRP professionals should reflect more deeply on how their goals align with those of their in-country collaborators. The consistent application of reflective processes has the potential to shift GHRP towards increased equity.
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Affiliation(s)
- Sarah Lebu
- School of Public Health, University of California Berkeley, 2121, Berkeley Way, Berkeley, CA, 94704, USA.
- University of North Carolina, Gillings School of Public Health, Chapel Hill, NC, USA.
| | - Lena Musoka
- School of Public Health, University of California Berkeley, 2121, Berkeley Way, Berkeley, CA, 94704, USA
- Georgetown University, McDonough School of Business, Washington, DC, USA
| | - Jay P Graham
- School of Public Health, University of California Berkeley, 2121, Berkeley Way, Berkeley, CA, 94704, USA
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Aliga A, Delbiso TD, Kitsao-Wekulo P, Lambon-Quayefio M, Moussié R, Peterman A, Tilahun N. Smart investment in global childcare requires local solutions and a coordinated research agenda. BMJ Glob Health 2023; 8:e012827. [PMID: 37666575 PMCID: PMC10481721 DOI: 10.1136/bmjgh-2023-012827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/19/2023] [Indexed: 09/06/2023] Open
Affiliation(s)
- Alex Aliga
- Department of Economics, Muni University, Arua, Uganda
- Research Department, Ace Policy Research Institute, Kampala, Uganda
| | - Tefera Darge Delbiso
- Department of Public Health Nutrition and Dietetics, Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Patricia Kitsao-Wekulo
- Early Childhood Development Unit in the Human Development Theme, African Population and Health Research Center, Nairobi, Kenya
| | | | - Rachel Moussié
- Women in Informal Employment: Globalizing and Organizing, Port Louis, Mauritius
| | - Amber Peterman
- Department of Public Policy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Natan Tilahun
- Programs Department, ChildFund Ethiopia, Addis Ababa, Ethiopia
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Nassiri-Ansari T, Rhule E. From inclusion to pluralism: how can we expand the epistemic languages of global health storytelling? Lancet Glob Health 2023; 11:e1009. [PMID: 37349029 DOI: 10.1016/s2214-109x(23)00253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Tiffany Nassiri-Ansari
- United Nations University-International Institute for Global Health, Hospital Canselor Tuanku Muhriz UKM, 56000 Kuala Lumpur, Malaysia
| | - Emma Rhule
- United Nations University-International Institute for Global Health, Hospital Canselor Tuanku Muhriz UKM, 56000 Kuala Lumpur, Malaysia.
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Wondimagegn D, Whitehead CR, Cartmill C, Rodrigues E, Correia A, Salessi Lins T, Costa MJ. Faster, higher, stronger - together? A bibliometric analysis of author distribution in top medical education journals. BMJ Glob Health 2023; 8:e011656. [PMID: 37321659 PMCID: PMC10367082 DOI: 10.1136/bmjgh-2022-011656] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/11/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Medical education and medical education research are growing industries that have become increasingly globalised. Recognition of the colonial foundations of medical education has led to a growing focus on issues of equity, absence and marginalisation. One area of absence that has been underexplored is that of published voices from low-income and middle-income countries. We undertook a bibliometric analysis of five top medical education journals to determine which countries were absent and which countries were represented in prestigious first and last authorship positions. METHODS Web of Science was searched for all articles and reviews published between 2012 and 2021 within Academic Medicine, Medical Education, Advances in Health Sciences Education, Medical Teacher, and BMC Medical Education. Country of origin was identified for first and last author of each publication, and the number of publications originating from each country was counted. RESULTS Our analysis revealed a dominance of first and last authors from five countries: USA, Canada, UK, Netherlands and Australia. Authors from these five countries had first or last authored 70% of publications. Of the 195 countries in the world, 43% (approximately 83) were not represented by a single publication. There was an increase in the percentage of publications from outside of these five countries from 23% in 2012 to 40% in 2021. CONCLUSION The dominance of wealthy nations within spaces that claim to be international is a finding that requires attention. We draw on analogies from modern Olympic sport and our own collaborative research process to show how academic publishing continues to be a colonised space that advantages those from wealthy and English-speaking countries.
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Affiliation(s)
- Dawit Wondimagegn
- College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Cynthia Ruth Whitehead
- The Wilson Centre, University Health Network and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family & Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
| | - Carrie Cartmill
- The Wilson Centre, University Health Network and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eloy Rodrigues
- Documentation and Library Services, University of Minho, Braga, Portugal
| | - Antónia Correia
- Documentation and Library Services, University of Minho, Braga, Portugal
| | - Tiago Salessi Lins
- Department of Health Promotion, Federal University of Paraiba, Paraiba, Brazil
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Adebisi YA. Decolonizing Epidemiological Research: A Critical Perspective. Avicenna J Med 2023; 13:68-76. [PMID: 37435557 PMCID: PMC10332938 DOI: 10.1055/s-0043-1769088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Decolonizing epidemiological research is a crucial endeavor. Historically, colonial and imperialistic ideologies have pervaded epidemiology, leading to an emphasis on Western perspectives and the neglect of indigenous and other marginalized communities' needs and experiences. To effectively address health disparities and promote justice and equality, acknowledging and addressing these power imbalances are imperative. In this article, I highlight the need of decolonizing epidemiological research and make recommendations. These include increasing the representation of researchers from underrepresented communities, ensuring that epidemiological research is contextually relevant and responsive to the experiences of these communities, and collaborating with policymakers and advocacy groups to inform policies and practices that benefit all populations. Moreover, I underscore the importance of recognizing and valuing the knowledge and skills of marginalized populations, and integrating traditional knowledge-the distinct, culturally specific understanding unique to a particular group-into research efforts. I also emphasize the need of capacity building and equitable research collaborations and authorship as well as epidemiological journal editorship. Decolonizing epidemiology research is a continual process that requires continuing discourse, collaboration, and education.
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Rubagumya F, Carson L, Mushonga M, Manirakiza A, Murenzi G, Abdihamid O, Athman A, Mungo C, Booth C, Hammad N. An analysis of the African cancer research ecosystem: tackling disparities. BMJ Glob Health 2023; 8:bmjgh-2022-011338. [PMID: 36792229 PMCID: PMC9933677 DOI: 10.1136/bmjgh-2022-011338] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/30/2022] [Indexed: 02/17/2023] Open
Abstract
Disparities in cancer research persist around the world. This is especially true in global health research, where high-income countries (HICs) continue to set global health priorities further creating several imbalances in how research is conducted in low and middle-income countries (LMICs). Cancer research disparities in Africa can be attributed to a vicious cycle of challenges in the research ecosystem ranging from who funds research, where research is conducted, who conducts it, what type of research is conducted and where and how it is disseminated. For example, the funding chasm between HICs and LMICs contributes to inequities and parachutism in cancer research. Breaking the current cancer research model necessitates a thorough examination of why current practices and norms exist and the identification of actionable ways to improve them. The cancer research agenda in Africa should be appropriate for the African nations and continent. Empowering African researchers and ensuring local autonomy are two critical steps in moving cancer research towards this new paradigm.
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Affiliation(s)
- Fidel Rubagumya
- Oncology, Rwanda Military Hospital, Kigali, Rwanda .,Oncology, Queen's University, Kingston, Ontario, Canada.,Research for Development (RD Rwanda), Kigali, Rwanda.,Oncology, University of Rwanda, Kigali, Rwanda
| | - Laura Carson
- Oncology, Queen's University, Kingston, Ontario, Canada
| | - Melinda Mushonga
- Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Gad Murenzi
- Oncology, Rwanda Military Hospital, Kigali, Rwanda,Research for Development (RD Rwanda), Kigali, Rwanda
| | - Omar Abdihamid
- Oncology, Garissa County Referral Hospital, Garissa, Kenya
| | - Abeid Athman
- Oncology, Coast General Teaching and Referral Hospital, Mombasa, Kenya
| | - Chemtai Mungo
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Nazik Hammad
- Department of Medical Oncology, Queen's University, Kingston, Ontario, Canada
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Dalglish SL, Sanuade OA, Topp SM. Medical Dominance in Global Health Institutions as an Obstacle to Equity and Effectiveness Comment on "Power Dynamics Among Health Professionals in Nigeria: A Case Study of the Global Fund Policy Process". Int J Health Policy Manag 2023; 12:7734. [PMID: 37579487 PMCID: PMC10125140 DOI: 10.34172/ijhpm.2022.7734] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/04/2022] [Indexed: 08/16/2023] Open
Abstract
Medical professionals exercised structural and productive power in the Global Fund's Country Coordinating Mechanism (CCM) in Nigeria, directly impacting the selection of approaches to HIV/AIDS care, as described in a case study by Lassa and colleagues. This research contributes to a robust scholarship on how biomedical power inhibits a holistic understanding of health and prevents the adoption of solutions that are socially grounded, multi-disciplinary, and co-created with communities. We highlight Lassa and colleagues' findings demonstrating the 'long arm' of global health institutions in country-level health policy choices, and reflect on how medical dominance within global institutions serves as a tool of control in ways that pervert incentives and undermine equity and effectiveness. We call for increased research and advocacy to surface these conduits of power and begin to loosen their hold in the global health policy agenda.
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Affiliation(s)
- Sarah L. Dalglish
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Institute for Global Health, University College London, London, UK
| | - Olutobi A. Sanuade
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Stephanie M. Topp
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
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