Global Health Matters
A podcast on innovative & inspiring actions to achieve health for all
Global Health Matters
Power and responsibility in global health
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In this episode, we turn the lens on ourselves as the global health community. Host Garry Aslanyan speaks with Hani Kim and Seye Abimbola about how elite global health actors can marginalize local perspectives and knowledge. They stress the importance of localizing efforts and acknowledging implicit biases to address the structural inequalities that perpetuate health disparities. Seye Abimbola is Associate Professor at the University of Sydney School of Public Health and inaugural editor-in-chief of BMJ Global Health, and Hani Kim is Executive Director of the Research Investment for Global Health Technology (RIGHT) Foundation in South Korea.
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Hello and welcome to the Global Health Matters Podcast. I'm your host, Gary Aslan. In this episode, we turn the lens on ourselves as the global health community, critically reflecting on both the intended and unintended consequences of our kindness in contexts beyond our own. This discussion is part of our ongoing series on decolonization and localization in global health, a theme we have explored over past four seasons. Previous episodes have featured insightful conversations with Olossojiade, Timri Scan, as well as a historical perspective from Sanjoi Bachataria and Anne Emmanuel Byrne. If you have not listened to these episodes, please go back and give them a listen. For this latest episode, I'm joined by Hani Kim and Sheya Abimbola. Hani is the executive director of the Wright Foundation in Seoul, Korea. Before this, she managed vaccine discovery and molecular surveillance grant portfolios at the Gates Foundation. Hani will be speaking in her own capacity and not representing the views of her organization. Shea is an associate professor of health systems research at the University of Sydney's School of Public Health. He was the inaugural editor-in-chief of BMG Global Health and recently published a book, The Foreign Gays Essays on Global Health. Join us as we unpack the complexities of kindness in global health. Hi, Shay. Hi, Honey. How are you today?
SPEAKER_03Very well, thank you.
SPEAKER_00Thank you very much, Gary, and hello, honey. It's nice to be with you.
SPEAKER_02Both of you in your respective fields and your work are very passionately challenging the current reality of global health. And as we start this conversation, maybe you could share a personal experience or an event that motivated you with this passion. Let's go with Honey first and then Shee.
SPEAKER_03So if I reflect back on what personal experience might have influenced my passion and views of what's being done under the name of Global Health, I think it must be the first 17 years of growing up in Korea. So I grew up in Korea throughout the 70s and the 80s at the time of democratization movement. And as some of the listeners may know, Korea's struggles for democracy are very much linked to its history of anti-colonial struggle to gain independence from Japan. So I think growing up in that context, I think I've become very much sensitized to power and how power operates, and having uh the affairs of your country, the fate of your country heavily influenced by other nations.
SPEAKER_02What about you, Shay?
SPEAKER_00It's really um striking how similar certain aspects of our growing up um are. So I grew up in Nigeria during successive military regimes. There was one coup d'etat after the other. And as a teenage boy in Buddhine school, in Bodin High School, uh my sense of who was a hero were people who were being killed and jailed and tortured and exiled for speaking up against the military regimes. Um and so for me, I grew up understanding that the way to be a human being, really, that the only way to be a human being is to fight power that seeks to oppress. And when I started to work in public health in Nigeria, I worked at the Ministry of Health, at the federal, Nigeria has a federal system of governance. Um I worked at the national government's primary healthcare development agency. And it was striking to me just how similar two sets of axes of power operated. On the one hand, when we at the national level would go to the states or local governments and communities to do public health work. First, we had power. Two, we were operating at a physical and sometimes social distance. Three, we were ignorant, but we did whatever we wanted to do, and we were allowed to do it because we had power and we had money. And in the same vein, also, because we were at the national level, we would often work with global, international actors who would come to Nigeria to do stuff. And they too were working at a physical or social distance, they too had power, and they too were very ignorant. And for me, it was just striking how similar sitting in between those two points of action were to each other, mirrored each other. And so I felt, again, with my sensitization to how power worked, um, it was for me important to commit myself almost to undoing whatever allows that to happen along both axes, whether it's the international to Nigeria, whether it's the national level to the community or local council levels in how primary healthcare works.
SPEAKER_02So much of the work in global health is about understanding inequalities and inequities that exist between people affected by certain diseases and trying to narrow this gap. Honey, in preparation for this episode, I've been reading some of your work and your views on health inequity. You regard health inequity to be a relational concept, and that's really stood out to me. Maybe you could explain to our listeners what you mean by this and how this idea influences our approach to global health.
SPEAKER_03I believe that the concept of health inequity is a relational concept.
unknownOkay.
SPEAKER_03And I think that's a very important one to acknowledge. So, what do I mean by that? That health inequity is a relational concept rather than an individual attribute. So health inequity is produced by and within social relations that govern production and exchange of concrete material things that we need to survive and flourish, to ensure well-being, like health. By material conditions, I mean how much we own and control various economic resources, resources that can produce things like money, land, credentials and labor and what you own, and how much of these resources you own, and control these resources, in my view, critically determine what you have to do to get what you need to ensure your well-being. Going back to the examples of economic resources, let's say there's a Korean woman that owns money or land or credentials, they're obtained in international elite institutions. And I count myself among those privileged persons. Then there can be a Korean woman who doesn't have a lot of money or land or credentials, but she has labor. Now, if you were to look at these two individuals, the two people will have vastly different strategies and choices that they have to ensure that they can bring healthy food, live and work in a healthy environment, educate themselves, acquire latest knowledge about health. So why relational? Because we cannot produce and uh buy and consume and exchange these things alone. We rely on this relationship of production and exchange. And in the capitalist mode of production and ownership, which is the current structure we live in, ownership and control of these resources are concentrated in a small group of people and in a small group of nations. And that's an inherent property of the capitalist mode of production and ownership. This is not an accident. The system is predicated on concentrating these resources. And many of the listeners, I'm sure, can appreciate the degrees, different degrees to which the own things translates into different degrees of power to influence the use of these economic resources and labor of others. In other words, I mean relations among different actors within global health, be it nations, non-government actors, private philanthropies, or stakeholder groups within nations, are deeply embedded in a system that's predicated on producing and reproducing inequalities of resources and power among and within nations. So to summarize, I would argue that these inequalities in the material relations and power relations have a profound impact on what strategies and directions that the field of global health employs to meet its goals.
SPEAKER_02Thanks for putting that into the way you describe that. It's really helpful. I'm gonna switch to Shea and ask him as he looks at this. Many current global health discussions focus on maybe achieving decolonization and localization and kind of deal with some of this. You wrote, and I quote, to make global health truly global is to make global health truly local. And you also envision a future where a new field emerges to replace what is now known as global health. I want to hear from you how these ideas we can take forward and share your vision for the future of global health.
SPEAKER_00Thank you very much. I was really enjoying Hani's exposition about inequities there. And the way that I think about global health, which is something I struggle, always struggle to define and make sense of. But the way that I think about it is efforts at whatever scale to reduce and eliminate those inequities, which often manifest in people's health and disparities in people's health. Now, there's one sense in which we may think of localization, which is us, in fact, making sure that whatever actions we enact in the name of reducing or eliminating inequities are done, taking the realities, the knowledge, the worldview of the people to whom, with whom and whose behalf we are doing it. In other words, localizing our efforts, beginning with what they want, what they know, what they are doing with knowledge, what they would like to see happen in their lives. That is what we often mean when we say localization. But there's another sense of localization that I'm interested in. Which, again, as Hani was describing it earlier, there's a sense in which those who have the power to do something about global health, right, often have that power because of the oppression and the dispossession of the people on whose behalf they are doing global health. In other words, there's a complicity that those of us who have the power and the resources to do these things, in fact, have in the reality that we are trying to address. So if, for example, I am the US government, I am a Gates Foundation, I am a powerful entity in a Western country who is in a position to do something in a small community somewhere on the African continent. I may choose to localize in the in terms of really focusing on what that community wants, what it needs, how it's processing everything. I could do, I could localize in that way. But I could also localize by working on my own power and privilege and saying, what are the arrangements that make me wealthy and powerful? So, how do I undo that? Is it a trade policy that I have that benefits me? Is it a uh a military policy? Is it some aid arrangements? Is it some financial arrangements with a capitalist entity? In other words, we can localize by focusing on ourselves and what we do to benefit. What benefits us in that arrangement? And we can localize by focusing on what people on the ground really want and need. And I think we have to hold those two ideas on localization in tension with each other whenever we set out to do what we call global health. If we do it right, if we do it well, if we do it in these two senses of localization, like properly, um, we will get to a point where the field will deserve a new name. In other words, it is not a prospective thing. It's not, we we ought not to gather and say, what are we going to call we do now? So let's change it. Let's gather together and change it. But we ought to work ourselves to a place where we look back and say, oh, it looks so different, so materially substantially different from where we were 10 years ago, that it almost itself that we call it something else. So that's how I wish we would think about what this other field might be.
SPEAKER_02Hmm. A lot to process here, um, obviously, and um let's hope that um we continue doing that. So let's continue and hear from Hani what she thinks, uh, particularly because you've given a lot of thought to um the disconnect in the language that we use in global health and the actions we take. And what do you think, in your opinion, are some of the unspoken or implicit values that often are unacknowledged, yet play a significant role in shaping these decisions or global health? What are your thoughts on that?
SPEAKER_03I think there can be a couple of things that I could highlight as what I would call implicit norms or implicit assumptions. What do I even mean by implicit norms and assumptions? I see it as something that is implied in our doing, regardless of what we say that we are doing. So there's some things that we act as if a world, a social reality is in a certain way. And first point, first implicit assumption, we act as if elites know best. That elites can fix complex problems like health inequity, leave it up to the elites and experts around the world. And before the elites, and I count myself among those elite, but when there's a concentrated power within the elite class everywhere, then there is an effect that you almost act as if that what elites can do is perhaps the only thing that can be done or the best solution. And in so doing, regardless of your intention, it has the effect of normalizing and universalizing the approaches and perspectives held by the elite class, and they emerge, their approaches emerge as the dominant narratives. And these dominant narratives then emerge at the cost of marginalizing views that do not align with the dominant narratives. So that is the first, I would say, uh important implicit value that I've observed since I began um being engaged in this field. The second one has to do with how health problems are portrayed. We the health problems are portrayed often as if they can be reduced to apolitical individual level causes. Instead of actually portraying the complexity of the context, the health problems are reduced to a function of these clean, neat individual level, cellular level, molecular level technical problems. We act as if the people make these individual choices with what we have outside social relations within which individuals, in fact, have to negotiate these resources to ensure well-being. When you sanitize a discourse around health and health and equity, um, devoid of this socio-political context and reduce them into this individual level attributes, this relational nature of health and equity is now kept out of view, meaning that it's kept out of critical inquiry, when in fact it is in that domain that we are likely to find root causes of health inequity. So I would say those are probably two aspects that I would really like to highlight as implicit values and implicit norms that often go unacknowledged and continue to shape decisions and actions in global health.
SPEAKER_02And not shape them in a good way, in a way, because we don't really go to the root cause of a lot of the issues, right?
SPEAKER_03That is right.
SPEAKER_02Right. Sheeh, in your work you also focused on exploring the lenses through which knowledge in global health is produced and disseminated, a very important area. Um you call these lenses one's gaze. In fact, uh the I'm sure you had a lot of thinking around the title of your book that has this word in it. And you described that there are two: a foreign and a local gaze on global health. So I want us to help our listener to explain uh how these two gazes or lenses can shape uh what we know to be true and how we approach our work based on the gaze we adopt.
SPEAKER_00There's something um tricky about the concept of gaze, and I will try to lay it very bare. And it is that gaze very often is something outside of us. In other words, we address ourselves to an audience, and that audience exerts power over what we say or choose to say, how we frame it, what we live out, what we embellish, etc. And it is that power, again, it's a very um relational concept. It is the power that that audience exerts on us that is gays. If I do research in Nigeria, if I do research in Zambia, and the primary audience to whom I'm addressing myself is in London or is in Boston. It would then mean, by extension, that I am not working to serve the knowledge needs of people in Nigeria or Zambia. I'm not working to impress them. But I'm working to impress someone, sometimes a journal editor, a funding uh panel member, um, etc., in London or in Boston. So that's one way of thinking about the foreign gates. Just the power that is exerted. And what that means, what that then means is that there are methods that I will not use, there are questions that I will not ask, there are frameworks that I will not adopt, there are lenses I will not use to process what I'm interpreting. Now, we can then do the flip around and say, what would it look like? If the premise of my research, my work, my policy making is in fact to serve the people who are marginalized. Right. What would it look like if the premise of my work is to first begin with what they know, what they were doing with knowledge, what their knowledge and learning needs are, and how I may serve that. Now, this is not a black and white thing. There are times when speaking to a foreign entity makes a lot of sense and is necessary. And there are times when addressing oneself to a local entity can be counterproductive. But those are exceptions. And that concept is what I'm trying a lot to make very visible in global health. That the fact that our literature looks a certain way is something that we don't even recognize. We think we are doing great research very often when we are not. That says if you're applying to a grant to an ex-entity, you can't say these things. You can't teach these things. You must teach this thing, you must pitch this method. And then we start to teach those methods. We start to dominate the literature. We start to train people to do exactly the same thing. And then it becomes the norm. And then we convince ourselves that this is the best thing to do. This is the only thing we could possibly do. And then it self-perpetuates. So for me, when I say gaze, that's what I mean. I mean that we have to be sensitive to what our audience has done to us and how it's shaped the landscape of scholarship in global health.
SPEAKER_02Interesting reflection in terms of how we also have this relationship with those that we think that's what they need to hear or they want to hear. And of course, the inspiration for this episode originally came from a dialogue episode we did last year with Soji Adei. He described several cases like in Nigeria, where millions of people are really reliant on kindness of outsiders or strangers for some of the most basic sort of health system things like vaccination or immunization. And I encourage our listeners to go back and uh search for that episode. So maybe switching a little bit to that issue of the kindness of strangers and this relationship we have with them, or those who have that power, or funding or uh say in sometimes what global health does, uh, and how it actually plays out. So maybe uh Hani, you can give us an example. You have significant experience working in large global health donors or with them or funding organizations who have, in a way, quite a uh sort of uh considerable power in how they shape global health and their own agendas or their own plans. What have you experienced to be some of the positive and maybe negative consequences of this um intense or charitable intense or you know um intents to help in this context that we're discussing?
SPEAKER_03I forgot to disclose during our introduction that among those elite institutions where I educated myself and worked in is the Gates Foundation. I spent about six and a half years at the Gates Foundation, um, and now I'm currently working at a funding organization supported by the Korean government and the Gates Foundation and Korean companies. So you're right, I have some experience of uh working in and working with um privileged global health um actors. So, what are some positive consequences um that I've observed? So, probably one area that I could highlight is the role of entities like the Gates Foundation in filling in what I will call the 1090 gap. So, some of the listeners might feel familiar with this term. This term 1090 gap was coined in 1990 by the Commission on Health Research for Development, refers to the observation at the time that less than 10% of global resources devoted to health research were put towards health conditions that affect um uh countries where 90% of all preventable deaths occur.
SPEAKER_02At the time was powerful.
SPEAKER_03That's right. At the time it was powerful. Entities like the Gates Foundation then directed their resources to fill this 1090 gap. And as a result, many essential medicines or vaccines or diagnostic tests that were simply absent or outdated because there's no commercial incentive have been developed. And um I can share two examples. One is uh a pneumococcal conjugate vaccine. Um, it's I think being sold with the trait name pneumocil. So now having this affordable and highly effective uh PCV has hugely contributed to reducing childhood pneumonia in the countries that were affected heavily by it. BCG, a vaccine to prevent um TB, this has been used since 1921. And it's effective in children, not so much, in adolescents and adults. So despite the public health needs, innovation in RD to develop a more effective TB vaccine has not really come about until big global funders like the Gates Foundation has directed their resources. So now one of, not the only, but one of the next generation TB vaccine candidates is in clinical development. So these are all good examples of positive consequences where these powerful international actors have contributed. Now, what are some negative consequences that were not intended? The approaches that are practiced or advocated by those elite institutes are the best or the only solutions to help to solve those specific health problems. So again, it has nothing to do with the intent of those individual institutions involved. But when we live and operate in a society that is deeply marked by social inequality, this is just the system that we are immersed in. So what matters is not so much the charitable intent, but the fact that these actions of an elite class that may have legitimate values, they end up portraying a worldview to justify, normalize, and universalize the approaches that are prioritized by the elite class because that is their worldview. So you pick up um, I wouldn't say any medical journal, but it's very quite common to read a conclusion statement at the end of a highly respected academic journal that would end with statements like we report an association between X and Y in people living in X country or X region with severe malaria. Therefore, X should be considered as a treatment strategy for malaria. And meanwhile, often these discussions are completely devoid of discussions of very specific sociopolitical context and what previous and ongoing efforts have been made in that specific local context, and how the new strategy that you're proposing in this esteemed journal might or might not fit with the experiences of the communities that are most heavily affected by and have attempted to solve the problem of malaria in their own context. So that's the negative consequence that I see.
SPEAKER_02Thanks for those um examples. And we probably don't do enough of that in terms of reflecting on that. Maybe let's come to the final part of the discussion today and see what are the actions that could help rebuild more healthier or promising global health system? So maybe share in the area of academic publishing, and that area that you've um also touched upon, uh have we made progress in terms of how knowledge is uh shared and how uh it's um disseminated and who uses it? So, what are kind of innovative approaches uh needed to create a more uh democratized and equitable system of knowledge sharing, in your view?
SPEAKER_00To the extent that we've made progress, I think we've made progress on the question of authorship. There was a time when it was accepted that you could go and do a study in Malawi and every author is based in the UK. We moved from that to it to an era, and there's this lovely, lovely title of an article that was published in DMG Global Earth when I was its editor that analyzed authorship patterns. And the title was Stuck in the Middle. So we moved from an era in which there was no Malawian author in this hypothetical paper to one in which all the Malawian authors are in the middle. They are neither first or second author or last author. Right? Just in the middle. And that took, I think that has taken quite some time for us to even begin to appreciate. And it takes, again, looking closely that ah, look what's been happening. They now include Malawians, but they get never in any power holding, ownership, signaling, responsibility taking position in the research. And now we are in an era where we're beginning to push ourselves more on who is the first or corresponding author or second, who is the last author. And you know, I think the next stage is to push against what Hani was saying earlier, which is who are these authors from Malawi really? Right? What do they bring? Like, where are the actors, you know, who were being studied? Where are the people who allowed access to the community? Where are the knowledge holders who ideally should help you frame and reframe your analysis? So that even if I, as a Nigerian, was doing a study in a community, right? That whatever whatever uh uh mental frame I had entering into that space ought to be sharpened and reshaped and challenged and reformed by people in the space in Nigeria where I'm working. And if that were to happen, then they would deserve to be authors too. In other words, if we are doing our research right, there are many categories of people who will qualify to be authors whom we don't even think about today as people whom we ought to think about as potential authors. So I think that's where we ought to go next. And in that space, then lies a lot of other things. One is um how transparent are we going to then be? Because there ought to be transparent about how where our questions came from, um, how our analysis was conducted, the mental frames and the frameworks and the logics and the worldviews that shaped it, whose was it? What was the process through which it was reshaped? Was it reshaped at all? Um, etc. Who helped develop our research processes and questions? Uh and then who, to what extent did those questions actually get to those structures and systems that shape the daily realities of people who are marginalized, that actually marginalized people? It's one thing to just focus downstream on what can what can I do? How can I change your behavior to cope with this inequity? It's another thing to say, how can we trouble the source of that inequity? How can we undo and reshape it? Again, to ask those questions. So I think we are almost like on the journey with academic publishing and research generally, which is you know, there was a time when it was very, very um um uh undemocratic. I think we're moving slowly, and I hope we quickly move towards a place where it is truly democratic. But these things don't happen by themselves.
SPEAKER_02Honey, in thinking about this um broader conversation on decolonization is happening, localization is happening. We had some of it here. Um and and of course, I go to different meetings, people don't want to use this these concepts in with this uh these names. Uh and there are good reasons for that, but I'm using them to just demonstrate the the trends, right? Do you feel um progress is being made um and with funding agencies to shift a little bit of that power into hands of countries? And if you have uh any thoughts on that?
SPEAKER_03Yes, I would say very carefully um and humbly, because I think uh we would all agree that there's still a long way to go. I do see some evidence of progress being made. Um, in a sense that I see I've seen more efforts, especially after uh the COVID-19 pandemic. I've seen more efforts made by powerful, uh, wealthy international actors to invite and listen to partners from the countries that um experience and have been attempting to solve the local health problems. Um I've just been sitting in more meeting rooms where um like half the room um was filled by uh institutions in um the countries from the global south, whether they're government or non-government entities or academic institutes, that I believe is definitely a sign, a step in the right direction. And from that, I would say that these signs indicate that we are now at the stage of inviting more people, more partners for the global south. Um, but I would caution ourselves when we invite partners, often, at least in the meetings that I'm familiar with, the people that are uh invited from the countries of the global south are elites. Um again, with the best intention of learning about and listening to the partners from the global south, but they're far from the people that you would see in uh the community health committees. These are elites from Nigeria, from Kenya, from Bangladesh. So as we as we invite these people, yes, it's a step in the right direction. We should continue to do so. And we are expanding the base of elites. And while it is a step in the right direction, let us keep in mind that perspectives from these elites, even if they're from the countries of the uh global south, do not represent the interests of the working class families in those uh countries. They do not represent the interests and needs and wants of the community member. We live in a structure where inequalities of resources and power are so pervasive that even within these countries, the inequality, the degree of these inequalities is immense. So finding out, figuring out what the working classes and the communities really want, this cannot be achieved simply by picking and choosing a few quote-unquote representatives from those countries. So then how can it be achieved? The needs and wants of the communities and the working class families are expressed through movements and actions that are built and led by the members of those communities of that working class in that local context. And that's an inherently a difficult thing to capture simply by selecting one or two representatives into forums and meetings and conferences hosted by elites. And here I think again, what Seya has mentioned about the gays is inescapable. You cannot hope to just walk across the meeting room to talk to who you believe are the representatives of, let's say, communities and working classes from Kenya in that context. Because you're not going to hear the real wants and needs of those communities and working class in that context. That's not how perspectives are shared. That's not how learning occurs about the marginalized and the oppressed and the um exploited classes occurs. That's not how it occurs. You have to really embed yourself within the communities and learn. That's the only way you learn, not through these meetings. So I think we have to be mindful of the inherent limitation. So it's a it's a it is a sign of progress that we are inviting these representatives from the global south. So I certainly uh don't mean to say stop because it's meaningless. No, it is a step in the right direction. So let us continue to do so. But let us uh keep in mind, let us not fool ourselves into thinking that you have then you will have captured the genuine um wants and needs that reflect the material concerns of the working class households in that local context.
SPEAKER_02So just to conclude our discussion and our listeners um have a bit more practical and actionable steps they can make themselves, and we don't come across all um only conceptual. Let's give uh a couple of um um pieces of guidance to them in their spheres of influence, where they work, they can use that, uh, and how they can begin sort of building um these um concepts in real life and in reality and make this change real. Share?
SPEAKER_00Very many of us, um, as Hani said, um, many of us who have power and privilege, um, find ourselves in global health, public health, as researchers. We very often then find that we are not doing what we really believe we should be doing. Um, in other words, that there are these structures that constrain us to do, to ask the question we really want to ask, to publish the paper we really want to publish, to do the things that we believe very deeply will be consequential. We often we then have two options. One option would be to bring ourselves to believe that what we do is the best and the right thing to do. In other words, to to tell ourselves a lie and to believe it. Or we can choose to leave with the discomfort. But there's something wrong here. There's something not working here, something not aligned here. What can I do about it? And what I often do is to encourage people to do the latter. To not not don't believe the lie. Don't believe that you know your the paper that is being celebrated. Blah blah blah is actually what you really want because you are what's really going to change things, you know. So first is just it's it's a mental discipline and exercise to not believe a lie, to not tell ourselves a lie. The second is about leadership, and there's something that's often said about leadership that often it's not the first person who is the real leader, is the second person who sort of says, I agree with her, let's follow her. It's the often that second person. And what that often means in practice is that very many efforts to change things are thwarted by that second person not standing up. So let us be that second person. When someone says let's do XYZ and we believe that it's the right change to be made, let us say what she said. Because that often is very, very important. And the third thing, and I will stop at number three, there's a tendency for us to think that we just do the right things without anyone asking us or pushing us. Even if we believe it for ourselves, let us not believe it for other people. Believing it for ourselves itself is a fiction. But but in other words, that if there's a change that is necessary, say in how we do research, in how we assign authorship, in how we do any of the any of these things, let us then imagine one step further and say what are the structures that can hold us to account for doing this. Because again, many change efforts die with the belief that it will just happen by itself. Things don't just happen by themselves. And again, this accountability structures are not always formal. So the example I give about authorship, which is that you know, people are just uncomfortable, so they ask questions. They look at you differently, they see your paper. That's probably like, what? That's an accountability structure. But there are other formal ways of doing it as well. So remembering that change does not just happen by accident or by auto autopilot, that often you have to build things. And to again, to be part of that building of the structures that constituen us to be right by people on whose behalf, with whom and for whom we ought to be working.
SPEAKER_03So I'm going to share two pieces of guidance that I strive for myself, far from having mastered either, but something that I've been striving towards. And I'm assuming that the most of the listeners of this podcast are a little bit more like myself and Seyin in terms of their material conditions, um, and not so much like the members of the working classes from like the fishing community in rural Kenya or farming households in rural Bangladesh or migrant workers in rural farms in Korea. In other words, um, we're probably a little bit more like elites than the most marginalized and the exploited classes around the world. So, given with that assumption, first guidance that I would like to uh share that I apply to myself. Do what you can in your domain, whether you are a student, a researcher, professor, policymaker, implementer, but know and be honest in acknowledging the inherent limitations of what you do. Let us guard ourselves against the temptation to portray a worldview where what we can do, just because that's something we can do, is the most important or the best approach. Solving health inequity is possible only when inequalities in material relations are solved. And solving inequalities of material relations will not be led by elites. Human history teaches us that the struggles for equality have been fought at one by the oppressed and the exploded classes, not by elites, quote unquote, helping them. That leads to my second guidance I would like to share. Identify and connect with whatever grassroots organizations and working class movements in your own context, be it an organization to provide affordable housing, to provide safe working conditions for the farmer, support for single parents, whatever it is. Identify and connect with that movement, learn about their struggles and their strategies to improve their material conditions and do whatever is feasible within your own domain to create conditions that are supportive of the organizing and mobilizing of working classes so that they can effectively advocate for their wants and needs and hold their governments to account to deliver what the government must deliver to protect the public. And remember, working classes are the lead, not the elites. And I just want to end with one inspiring example that I recently come across just to illustrate that there's something that can be done by elites. Just read a paper published by a researcher in an elite university in Korea, and this group has published for the first time undocumented deaths of migrant workers on the job. The data were powerful as they were used as an instrument, a tool for the group of migrant workers and workers, um, the Korean workers that were united in their efforts to advocate and pushing the Korean government to improve regulation over work environment, to provide a safer working environment. So there can be something that uh that elites can do, but I think it's important. I would really urge ourselves to identify and connect and support these working class movements that are multifaceted in your own local context.
SPEAKER_02Hani, Shea, thanks a lot for this conversation. And uh let's continue working in this area.
SPEAKER_03Thank you.
SPEAKER_02Thank you very much for having us. These thoughtful and honest reflections from Hani and Shee have given me much to consider. Personally, I take away two key insights, which you, our listeners, uh, may also benefit from. First, the importance of self-awareness and reflexivity. Understanding my own worldview, position, power influence how I engage with my work. And also makes me conscious of the limitations of my ability to influence change. And it all depends on the setting and the audience. Second, the value of embracing discomfort. Global health is a complex field shaped by numerous factors and relationships. It has its messy history and continues to have as we speak. While challenges are inevitable, what encourages me is the knowledge that we all have a role to play in shaping its future. Now let's hear from one of our listeners.
SPEAKER_01Hi! I am a listener of the Global Health Matters podcast, and I wanted to share with you an audio note of Thanksgiving for three reasons. One, Global Health Matters does some really wonderful work that brings together the highest levels of global health in the WHO and the frontline workers really pushing things forward at the last mile. I think that's remarkable and so unique within the podcast world. Second, Global Health Matters is an exceptional team. I mean, it's really an exceptional and wonderful group of people. And third, the curation and the attention to detail are also um unusual. I think it's really a carefully curated uh podcast. And I'm I'm so grateful for being able to listen to it.
SPEAKER_02Thank you, Joe, for your message. I'm so pleased you find value in hearing from so many diverse voices we bring to the podcast. To learn more about the topic discussed in this episode, visit the episode's webpage where you will find additional readings, show notes, and translations. Don't forget to get in touch with us via social media, email, or by sharing a voice message. And be sure to subscribe or follow us wherever you get your podcasts. Global Health Matters is produced by TDR, a United Nations co sponsored research program based at the World Health Organization. Thank you for listening.
