Global Health Matters
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Global Health Matters
The future of global health is through diversity and dignity
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An important Global Health Matters podcast topic this month, discussing the need to build an awareness of the ways we interact with colleagues in the workplace to adapt our programmes to be more inclusive. We need to talk about “the future of global health through diversity and dignity”. Host Garry Aslanyan interviews our special guests who have a deep understanding of diversity and dignity and their application worldwide.
Our first guest, Marie Ba, is from Ouagadougou Partnership where she advocates for reproductive health and development across West and Central Africa. Marie Ba questions whether diversity is just a tick-box exercise, ensuring that we break down the definition and elements that make up the term “diversity”.
Tom Wein is based in Kenya where he leads research on dignity in development with IDinsight. By analysing further the two concepts of diversity and dignity together, the link is formed and shows that representation is only one aspect, and that agency and equality also need to be factored in to realize dignity within diversity.
Join us in this podcast episode to develop a broader understanding of the future of global health through diversity and dignity.
Guests are:
- Marie Ba, Director of the Ouagadougou Partnership Coordination Unit
- Tom Wein, Director, Dignity Initiative IDinsight
Related documents, transcripts and other information can be found on our website at
The future of global health is through diversity and dignity (who.int)
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Hello and welcome to another episode of the Global Health Matters podcast. I'm your host, Gary Aslanjan. It's great to welcome you back, our listeners, who now span over 134 countries. Thank you for your ongoing support of this podcast. As many of you, I follow with a lot of interest the current dialogue and debates on the future of global health. Academics and practitioners from North and South are really considering a lot of aspects of global health practice that need to be reimagined. Equity, inclusion, further localization. All of these have become aspirant goals receiving unanimous support. So in this episode, we will be discussing the role of diversity and dignity and how these two factors can enhance global health. For this conversation, I'm joined by Marie Ba and Tom Wayne. Marie is the director of the Wagadougou Partnership Coordination Unit based in Dakar, Senegal. Marie has extensive experience in fostering partnerships and managing health programs in West and Central Africa. Tom is the director of ID Insight, based in Nairobi, Kenya, leading various research initiatives, and Tom also is the founder of the Dignity Project, a campaign promoting more respectful international development. Hi Marie.
SPEAKER_05Hi Gary, how are you?
SPEAKER_04Hi Tom. Hi, Gary. Hi Marie.
SPEAKER_01Really glad to meet both of you.
SPEAKER_04I'd like for us to start by unpacking the key terminology in our discussion we'll be having today. So we are all on the same page and have a common understanding. In summary, the term diversity holds many connotations in global health and development. Marie, in your piece that you published in the Lancet Global Health, you mentioned that the term diversity entails representative participation, which has often been reduced to a checkbox exercise. What else would be important for you in using this term?
SPEAKER_05I think diversity is the hot new thing I feel in the past couple of months. And I think even though it may mean a lot of different things to different folks and different people, to me it shouldn't be limited just to representation. I think it's one aspect of it, of having meaningful diversity through representation. But I think it's also very important to have decision-making powers and leadership powers in that diversity. And I feel like that's what lacks a time where you have diverse looking, either staff members, crew, or board members, but not in actuality very diverse. And so being able to meaningfully shift the powers, if all we do is look at representation, we're only going to end up with gimmicks and not real power shifting. And so addressing the system, meaning funding streams, meaning decision making, shaping the global health agenda, is also extremely important.
SPEAKER_04So, Tom, you just heard from Marie that the term diversity has become a very popular term in global health and in development. However, in your work, you've emphasized the term dignity. What do you mean by dignity and why it's important, especially when we talk about diversity?
SPEAKER_01Dignity to me is about this fundamental, inalienable quality that every human has that means they ought to be treated in a certain way, in a way that recognizes or respects their dignity. That work then leads us to a whole range of ways in which we might change our behavior. And I really I love what Murray was saying about these fundamental changes to the power relations that might be necessary to achieve that. We're in the middle of these really extraordinary campaigns and changes for greater racial justice, greater gender justice. I hope that dignity is never supplanting or taking energy away from those campaigns that have their own fully worked out language and frameworks and don't need me to suggest how to go about them. One thing that I hope dignity can do is extend those to all the ways in which people want to be treated, to be treated as their best selves, as full, complex humans in all the interactions they have with other people and with institutions. And that I hope is what the Dignity Initiative can start to lead us towards.
SPEAKER_04Marie, the Wakadogum partnership that you worked in has been very successful in looking at localizing and giving opportunity for country-based leadership. You already alluded to that in your definition. Maybe you could share with us some of the factors that enabled this to happen?
SPEAKER_05So I think, first of all, just in the name, from the beginning, this was set up as a partnership. Um so it never really felt like a grantor, funder, grantee relationship. Um I think even at the at the offset, um, it was set up for success. Um and then every single partner and member who joined the Wagadugu Partnership really felt this equal um opportunity and an equal partnership between these nine Francophone West African countries as well as the you know powerful donors that were um funding some of these health programs. So I feel like that was the first step in setting us up for success. And then it's it's been a process. It's been we've been um um on board now for about 10 years. So it took really 10 years to mature into a partnership where there was enough trust um to actually set us up into this localization. And one other very important aspect um is this generational renewal. And I feel like really having this new generation of African leaders and talents who are um uh maybe a bit more pushy and and and you know, fierce and and bolder in making that localization happen was also instrumental in setting us up for this local um entity, was uh instrumental in making us what we are today.
SPEAKER_04Early on, the approach taken really is an important factor in how the outcome is unfolding or unfolded over the 10 years period. Yeah, yeah. Exactly. Thank you. Tom, you mentioned that uh dignity is a universal human trait or human desire, obviously. It would be simplistic to assume that this is experienced in the same way by all people. From your research, uh, if we were to look and see across different settings, how is dignity experienced across different countries and cultures?
SPEAKER_03I think this is a really important question.
SPEAKER_01Dignity is one of these things that appears in virtually every theological tradition, philosophical tradition. Almost everybody who's talked about morality has had some idea of this is what makes people special, this is what we owe to people and how they ought to be treated. But of course, those traditions vary and popular understandings vary too. Because of that, I think it's profoundly important that we keep doing good qualitative research and keep understanding the subjective experience in every new place and every new context that we're that we're trying to uh understand uh dignity. There's a Western idea of dignity that is um uh comes out of Western philosophy, descends from in part from Immanuel Kant, which is um about each individual having this uh this trait, and therefore they must be treated in this way. And that's kind of what I sketched out in my first answer. And that's fine as far as it goes. That's actually not a bad thing that takes us quite a long way across a number of different global traditions. But I did some participatory research with uh the activists of the Mathari Social Justice Center here in uh in Kenya. Mathari is a very tough neighborhood. The Social Justice Center have been fighting for um greater access to many of the things that they are supposed to be granted in the constitution and that have not been achieved, not least freedom from police violence. The activists there told me, as we came to a consensus definition, two things. They said that that Western definition works okay for us. But there are two things you need to know that are that are missing from that definition. One is capability, and the other is purpose. So they said, yes, of course you should treat people in this way, but not everyone has the capability to do that. You need a basic foundation of self-respect, capacity, self-efficacy, uh perhaps some material resources in order to create the mental room to treat others in the way that you would aspire to. And they told me that we do this for a reason. The reason we show respect to one another, the reason we take care to notice one another, is not just because a philosopher tells us to. It was, in their opinion, because it gives us the opportunities to care for one another and to discharge what they viewed as their God-given duty to provide care for one another. And I think we could talk about other traditions. There's been great work done, for instance, by the Overseas Development Institute on understanding of dignity in Colombia and the Philippines. We're doing some qualitative work in Uganda right now. Um, and there's lots we could talk about. But I think the important thing to note here is there are these varied traditions, which is why we have to keep embedding it in the subjective experience of people to they feel they were treated in the way that they would hope.
SPEAKER_04From where you are, Marie, what do you think of this issue of settings and dignity that Tom just alluded to?
SPEAKER_05I really appreciate him talking about this because at times I've questioned myself, why are we doing this? Or I've questioned other people's intentions as to why they were interested in working in global health or in international development globally. So I started, and even before I started my career, when I I remember I was in school in the US, and both universities I went to were not the most diverse. Um and I remember one student in one of my um international development classes mentioning that maybe we should go back to colonization as an answer to how the West or the global north could best um help Africa um succeed. And I, you know, obviously I froze, but then, you know, even within my career, there are so many instances where I've rolled my eyes in a meeting or or read an email where I felt so much condescendence at times, um, sometimes pure ignorance. And that's always because at some point, either the system or the people have removed this aspect of morality and dignity out of the equation, which I think is just so important um and that we really shouldn't bypass.
SPEAKER_04Mm-hmm. So you've alluded to your personal and professional experience. Based on that experience and the reflection you just had, what do you think can be done to achieve genuine diversity such that global health goals can actually be achieved? How do you do this in your work?
SPEAKER_05So I think first you probably need to have very uncomfortable uh conversations, fortunately or unfortunately. Um and I think that has started, which also triggered just the this mayor podcast we're we're on. So all of these conversations where I feel like the global north needs to give um a safe space for us, for you know, African or or um minority or um middle income countries leaders um to actually voice what some of our needs are. Um because most of the conversations that I've heard so far about um shifting powers or um uh the sometimes the lack of diversity has mostly come from the north. It's I haven't I don't feel like we've had enough of these conversations, even amongst ourselves in the global south. And I think that's what we're missing. So being able to share ideas, what are some of our asks to set us up for success in the in the future? Um, so first having those conversations, but then also being able to step away from the conversations and really going into action. Um, so this doesn't end up just being conversations. Um, and I think we also need to be deliberate and understanding that there is a system in place that is intentionally or unintentionally designed, uh, keeping this imbalance, being very honest and crude about it, um, and seeing how we can we can fix that.
SPEAKER_04Mm-hmm. Tom, do you have any observations on Marie's uh assessment?
SPEAKER_01Yeah, I think Marie's right that these conversations are really important. We did some research with American nonprofit staff and asked them what helped them commit to a culture of dignity, even when that meant real sacrifice for them. And a couple of things seemed really important. One was managers talking about it and giving them a permission structure to say, yes, we're going to go ahead with this. And the other was listening to those who've experienced disrespect in their own lives, who have felt that experience of being maltreated, and making sure that their voices were leading the conversation, even if that was leading them sometimes to be kind of cynical about this cause, who were saying that you know, that therefore development doesn't always practice what it preaches. Those people are really important to be listened to. The third final thing I'd add is there are ways that we might try and change an organization and structures that you might use, of accountability, of measurement, and so on. Before we get there, every organization should know that there are places they'd be getting this right. This is not an impossible ideal. We will all have our favorite examples. I deeply admire Partners in Health, as I'm sure almost everybody does. I deeply admire the work that Altogether in Dignity Fourth World have done. I used to work for a place called Raising Voices, which works to prevent violence against women and children in Uganda. All these places are places that have really built cultures of dignity through constant reinforcement internally, and have can show us the way, can show us this is not unattainable. And I think that's really important for people to know. Mm-hmm.
SPEAKER_04So, from the work that you've done, you mentioned in the reading that I had that there are three pathways to disrespect. So maybe we can unpack that a little bit more. So agency, representation, and equality. What are the recommendations that you have for the global health researchers or practitioners on how these three aspects can be taken into greater consideration when designing health programs? And then we'll see what Marie thinks of that.
SPEAKER_01All the way through my answers today and all the way through all the work I do, I'm really emphasizing the subjective experience of the person with the least power in any interaction. If they say that they feel they've been treated in a way that respects their dignity, they have. And if they don't say that, they have not been treated in the right way. Regardless of what else we might have done or how how some global development actor may feel they've acted, whether no matter how good the intentions were, it has to come down to that subjective experience of the person with the least power in interaction. Now, that subjective experience is going to vary enormously from place to place, as we were saying. But when we do study these different traditions of dignity, and when we ask people what's important to them, we seem to see these three pathways recurring of representation, agency, and equality. Representation is about people feeling seen by the institutions that they're interacting with and seeing themselves represented in those institutions. Agency is about having choices and a meaningful chance to consent for the decisions that are being made about their lives. And equality is about the power inequalities being reduced, and even where they cannot be eliminated, people feeling treated as if they were fundamentally equal, even if those power of differentials persist. And those three pathways I find are great starts. We use them in the workshops we do here at Idea Insight, because they're a great way of beginning to generate ideas, and those ideas will vary depending on what uh what program you're operating, what type of organization you are. But there's a I think everybody can begin to think about ways in which people could feel more seen, better represented, ways in which people could have a better chance to consent, and so on. I think those three pathways are a great place to start for brainstorming ideas for for almost any program.
SPEAKER_04Mm-hmm. So kind of look at how our audience, our listeners uh who are going to take some of these messages and see how they can adopt that in their programs. Marie, how would you use this to build on the work that you've done already?
SPEAKER_05So I really like this idea of these three pathways. And I think unfortunately, we've we've focused so much more um recently on representation being seen and giving a voice to the global south, which is very important. But I think where we we lack a bit more is on agency and equality. Um and I think that's how we get to really meaningful power shifts. Um and those are some of the conversations that I've had with certain colleagues who noticed the same things. And in the beginning, you feel like, wait, is it just me? Um, and then you realize it's not just you, it's not uh just this one time that it happened, um, that it happened also to colleagues in the field. So really being able to get a sense of what those perceptions are, and as Tom has put it, I I mean, whether you're talking, you could be talking to two people and they would have varying, very different experiences. So I think taking most of them, if not all, into account is also extremely important. But as far as I can um I have experienced so far, a lot of the focus, and I think it's the easiest, usually, right? You just go to representation because that's the the easiest one to be seen and tick that box, um, as we've we've mentioned before. Um, and the really hard work, I think, is really working on agency, on equality, and really shifting those powers. And I've I think Tom alluded to that. Um, it's not about transferring a hundred percent of the power over to the global south. I understand that there might be some uh worries about this new agenda, but I think it's just a matter of um equity and and um and equality. And we see the same fight when it comes to race relations, exactly the same fight when it comes to gender equality, it's just about giving um less of a head start and less privileges to one side over the other.
SPEAKER_04Are there any other points around examples or the pathways towards finding solutions you'd like to add?
SPEAKER_01There was one more point I wanted to make, which is that everybody across development has good intentions and wants agendas like this to succeed. We can certainly brainstorm more solutions. I hope those three pathways are an interesting and valuable framework through which to do it. We know that initiatives like this have failed before. There have been a lot of efforts to reform global health, to reform global development. One way in which we can help make sure this has a better chance of success is by holding ourselves accountable. And I think a crucial part of that is measurement. It's perhaps a shame in global health and development that we always need to look to quantitative measures, and we're not great at digesting qualitative evidence, but we know that kind of is true. And a really central part of what we've been doing here at the ID Insight is thinking through quantitative measures that can be validated, that can be demonstrated in different contexts and different situations, that focus on people's subjective experience of how they were treated and whether they were treated in the way they would aspire to be. And that um developing those measures, I think, is absolutely crucial to this work because it's what's going to allow us to check our progress, to trial new improvements, and to hold ourselves accountable when we fall short of this promise to uphold everyone's dignity.
SPEAKER_04Marie, did you want to add anything?
SPEAKER_05For me, uh beyond what Tom just mentioned, I think that's Idea of accountability and good intentions, it needs to come from both sides. I know we talk a lot about shifting powers, decolonizing global health, and really putting the focus on the global north, but I feel like there's some work that needs to be done from the global south first. I think there needs to be, and it doesn't have to be a consensus, but at least understanding what some of our asks are, what some of our needs are, um, what some of the issues, um, I think that's the other one aspect that we usually just completely um forego and and put probably too much focus on hearing voices from the global south and then pointing fingers at the global north. And I feel like they're, you know, it needs to be vice versa, where both experiences also can be heard. Um to me, it would only add to the dialogue that we're having, um, and and really making sure that we're setting up good intentions at the end of it and being um reactive and really making it sustainable so it doesn't end up just being conversations.
SPEAKER_04So despite our goals of achieving health for all, maybe each of you could share with our audience what helps you to proceed and process this difficult experience that you've had such that you can still hold to a more hopeful vision of the future.
SPEAKER_05I entered this field of global health full of ideals and and good intentions. And as you said it, uh, you know, it's easy to get cynical. And I I did, I think I I got to that point. Um, and that's why sometimes I call it a business. But uh I think it's also very important to recognize that um times are evolving. I feel like um from when I first started to now, I've met so many wonderful global health leaders or global health actors who genuinely want to help um change that system, the the status quo, the way things have been done in the past. So, you know, even having uh a listening ear from donors, for example, within this Wagaduga partnership, um, I feel like we've been supported um so far in all of these issues that happened and took place. And so that to me brings me hope. And this other point that I also mentioned about um making room for youth, but because I feel like they're, you know, in in their approach, uh willing to question the status quo. I remember when I started, I I had so many questions about why are we doing it this way? This doesn't make sense. Um, but what do you really if if you set it up this way, there's no way that you know the field could be successful. And so um seeing other youth, other people who look like me, um, who actually question it, other people who don't even look like me, who also question that, I think brings me hope that um though it's a it's a difficult question and a difficult matter to to uh to resolve, that there's a possibility that at the end of this long process and it takes time because it's a whole set of norms that you're trying to uh to shift. Um, I think at the the end of this very long process, we could come up with a much equitable um partnership, is what what it would feel like.
SPEAKER_03Tom, what are your thoughts for the future?
SPEAKER_01Social change theorists like to talk about critical junctures, these moments when much greater change is possible. You spend years butting your head against the wall and nothing happens, and then suddenly everything seems to shift. And they're always a bit vague about how you identify when you're in a critical juncture. It seems pretty important. But if ever we're in one, it must be now. Everything feels like it's changing. This is a moment when so much seems to be shifting in ways that are profoundly exhausting. It's really hard to keep getting up and saying, my goodness, the world has changed again overnight. But if ever there was a moment when change could be affected, it feels like now. That exhaustion, that's how I think about change perhaps at the global level, but that exhaustion is very real at a personal level. For me, there's only two things: there's people and the work. And when I'm not sure how I'm ever going to achieve a change in a year or two years or six months, I can still lose myself in the work that day. And look to the left and right of me. Are there a bright, idealistic people who are trying to do the same things with the greatest standards of research rigor and dedication and hard work? And that helps a lot. Losing yourself in in the work alongside people who are doing the same is um is all that's ever worked for me. Um and I guess everybody has to find their own solution, but that that's certainly how I continue to find uh energy each uh each time.
SPEAKER_04Marie, Tom, thanks very much for joining for this really interesting discussion. Thank you, Gary.
SPEAKER_05Thank you very much, Gary. Thank you, Tom.
SPEAKER_04Thank you, Marie. As Marie and Tom have highlighted in this episode, diversity is so much more than representation. Diversity is closely linked to dignity, and if separated, it can become what Marie called a checkbox exercise that fails to shift the dominant power dynamics. I found Tom's insights from his research in Kenya fascinating and constructive. Although dignity has a universality to it, it can also be regarded as a capability that if lacking can result in the best intentions achieving rather unintended and even hurtful consequences. Strengthening one's own dignity capability should be a daily intention that all of us in global health pursue. In so doing, we can hopefully foster more respectful engagement in global health, making everyone feel seen and valued. Before we end, we wanted to share another clip we received from our listeners.
SPEAKER_00Hi, my name is Mary. I listen to the podcast from a windy little village about 200 kilometers northwest of Cape Town in South Africa. I love hearing the stories and experiences of researchers and academics from all over the world, especially those who are not stuck only in big urban centers. And I'd love to know if anyone is doing research on the environmental impact of the health sector and ways in which that could be reduced dramatically and quickly and yeah, in ways that are according with what's needed in our world at the moment. Thanks, bye.
SPEAKER_04Mary, thank you for listening to Global Health Matters all the way from your windy town in Western Cape in South Africa, and for your suggestion for a future episode. Tune in again next month for yet another motivating episode. Remember to subscribe and share this podcast with your colleagues and friends, and sign up for our Global Health Matters newsletter. In this way, you will be first to know when a new episode becomes available.
SPEAKER_02Global Health Matters is produced by TDR, an infectious diseases research program based at the World Health Organization. Gary Aslanian, Lindy Van Niekerk and Maki Kitamura are the content producers, and Obadiah George is the technical producer. This podcast was also made possible with the support of Chris Koes, Elisabeth Adesti, Isa Studel Dayau, Noreen Ogalaer, and Chembe Collaborative. The goal of Global Health Matters is to produce a forum for sharing perspectives on key issues affecting global health research. Send us your comments and suggestions by email or voice message to idrpod at wo.int and be sure to download and subscribe wherever you get your podcasts. Thank you for listening.
