Transforming Ourselves Through Global Health Research

Global Health offers a wealth of opportunities to break the chains of the colonial mindset and foster more egalitarian relationships between researchers and institutions from different continents.

The person I am today (with my values, priorities and scientific knowledge) is the result of the opportunities I have enjoyed in countries with limited resources. I am grateful for the people and institutions that opened their doors to me when I was beginning my path as a researcher. These include the Instituto de Inmunología in Colombia, the Centro de Investigação em Saúde de Manhiça in Mozambique and the International Center for Genetic Engineering and Biotechnology in India. I am also very much indebted to them. These experiences have prompted me to question my way of relating to colleagues and friends from less resourced countries, and to identify attitudes, sometimes prejudiced, that condition my scientific work, as well as my personal behavior.

This self-examination led me, a couple of years ago, to share an exercise of reflection with colleagues from Spain, Mozambique, Ethiopia and Benin on the collaborations in which Global Research is usually framed. I have always been concerned about the privileges (in terms of geopolitical location, race, class and gender) that years of colonization have introduced in the relationships we establish. This reflection is more urgent now when solidarity towards the neediest seems to fade on our horizon. It requires our attention not only to research outputs, but also to the process of making and doing research.

Difficult conversations needed

We are still dealing with the aftermath of colonial history. This is clear at the political level (in terms of international relations), the economic level (in terms of funding and resources), and the epistemic level (in terms of beliefs, thinking, and knowledge). This historical imbalance has allowed former colonising countries to tackle health challenges that are commonplace in former colonised countries, creating a foundation for dependent relationships and even subordination. We must break the chains of the colonial mindset to foster more egalitarian relationships. Awareness of these privileges and asymmetries that do not serve all people equally can help us develop strategies that foster more equitable relationships.

Global Health offers a wealth of opportunities for this. Coloniality, power and equity are key concepts that can frame the difficult conversations needed to transform mindset and ways of collaborating. But these concepts have become so integrated in our vocabulary that they have lost their power to stir consciences. The challenge is to transform these abstract ideas into pragmatic action. This requires collaborations between people and countries with profound asymmetries and finding together the way to move from aspirations to tangible changes.

Collective reflection

A transformative collaboration identifies a set of goals toward which the partnership wishes to work and agrees on the process for accomplishing them together. Transformation is achieved through collective analysis and awareness of positionality (to challenge inherent assumptions and privileges), solidarity and togetherness (to create an interconnected view that transcends differences), and shared responsibility for actions and outcomes (to ensure an effective relationship). A collective reflection on how and why the desired changes will occur is needed to plan "who will do what, how and when", and together advance through equity-centred actions. A mutually supportive role, generosity in balancing interests, and adaptability will allow us to adjust our working rhythms to ensure that we all walk together towards a common objective.

It is about what we are willing to do (and how we do it), not what we are able to imagine, that will make a difference in realizing the full societal value of Global Health research

Transformative partnerships enhance mutuality and bilateral benefits, but not in the form of calculated and expected returns. It is vital to plan this reciprocity  carefully and to value it equally to research outputs. The principle of subsidiarity favours filling capacity gaps in less powerful partners working where the health challenge lies. Conducting activities in these contexts, rather than opting for the most cost-efficient approaches such as sending samples or data to well-established institutions, is key to breaking down the barriers that prevent the full potential of the capacities already present within partners. Often the capacities are there: the challenge lies in implementing them.

Complementary attitudes can pave the way to achieve this. The most advanced partners need to empathise with the challenges others may face (technical, contextual, social, political and institutional, among others). The less powerful partner must consider the needs and means (including better governance) of actively gaining agency to play a greater leadership role. Attention is needed to respect commitments, which defines each partner’s level of trust, as the willingness to open up to the other is determined by the other’s sense of integrity, competence and credibility. A science culture that thinks in longer time scales, engages in value-based decision-making and takes responsibility for the power relations embedded in research is key to promoting and fostering a balance based on equity values.

New ways of working and leading

We can accomplish more when we work together toward a common goal that we all believe in. This increases the likelihood of finding solutions and creates a sense of shared satisfaction that enhances our own happiness and well-being. However, working with people who have different perspectives, priorities and capacities requires time and efforts. New ways of working and leadership styles can foster a truly global research environment and sustainable development. These must be more collective than individual, more collaborative than competitive, and more coaching than commanding.

The key to progress lies in shifting from general principles drawn from our desks to specific actions if we want to foster the collective mobilisation of global intellect, ambition, and action that global health requires. It is about what we are willing to do (and how we do it), not what we are able to imagine, that will make a difference in realizing the full societal value of Global Health research.