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Inaugural Symposium Highlights Need for Allyship and Equity in Global Health

April 17, 2024
by Colin Poitras, Alyssa Cruz and Cindy Rodriguez

Nearly 200 people attended the Yale Institute for Global Health’s (YIGH) inaugural Global Health Symposium on April 5. The day-long event featured opportunities to learn about YIGH programs, including seed grants, faculty networks, and fellowship opportunities for students. There was also a session on how to navigate Yale's policies to support global health programs, and lightning talks on a wide variety of faculty and student initiatives in global health.

But it was the powerful keynote address by Professor Madhukar Pai, MD, a leading international voice for global health equity and chair of the Department of Global and Public Health at McGill University, that best captured the day’s focus on re-envisioning the future of global health.

In an address that would later be described as “searingly honest”, “inspiring”, and “essential” to anyone working in the field of global health, Pai spoke on, “Building Equity in Global Health: The Role for Global North Actors.” A complete recording of Dr. Pai’s address can be found on Yale University’s YouTube page.

Backed by extensive research and analysis, Pai showed how every aspect of global health today is dominated by Global North individuals with power and privilege. He said that if global health is truly to be reimagined or decolonized, Global North actors must shift from saviorism to allyship. He concluded his presentation by sharing several examples of how greater equity is happening in global health. But he described the advances as “baby steps” that have only been possible through allyship, sustained focus, deliberate intention, “and lots of hard work.”

“Global health has a long history of failing on equity, again and again and again,” said Pai, who grew up in Vellore, India and is a leading researcher in the diagnosis and treatment of tuberculosis in vulnerable populations. “The field itself is structurally inequitable. And I argue that a structurally inequitable field can never truly solve inequities…regardless of how good individuals are, it is not designed to solve it.”

“To bring equity,” Pai continued, “not only do we need to shift from saviorism to allyship, we have to confront the serious obstacles to allyship within our institutions.”

He noted how largely white, male, well-educated professionals from the Global North dominate the largest global health organizations of the world, oversee the dispersion of massive amounts of private research funding, and control the editorial agenda of the world’s leading scientific global health journals.

“We are the gatekeepers of knowledge in this world, dominant, beyond dominant,” said Pai, who early on acknowledged his own privilege as a highly educated male professional working at a leading research institution in the Global North.

“The bottom line is that you and I hold enormous power and privilege in global health,” he said. “To approach this field without a deep appreciation of our own power and privilege is a massive mistake.”

Pai cited the COVAX initiative as a “stunning example” of a well-intended yet “totally naïve” attempt by the Global North to help the Global South in a way that utterly failed to recognize the region’s true needs and realities on the ground. The historic multilateral effort was intended to guarantee fair and equitable access to COVID-19 vaccines to all countries of the world. But in reality, COVID vaccines were hoarded in the Global North and African countries lagged far beyond others in getting badly needed vaccines during the height of the pandemic.

Pai said that if global health leaders in the Global North had truly listened to what their peers in the Global South were saying, the response would have been different.

“What our Global South colleagues are clearly articulating…and they have said this in article after article, is that “We are sick and tired of this charity model,’” Pai told the audience. “We want to make our own damn vaccines…just give us the recipe. We’ll take care of it.” Yet, we still don’t have a pathway for manufacturing vaccines where it is needed most.”

Pai said that he frequently attends conferences in the Global South where he hears time and time again from public health leaders who want to determine their own agenda. They want autonomy and respect, Pai said. They want the Global North to be an ally not a savior.

One way Pai has personally worked toward advancing equity in global health is through his role as editor-in-chief of the journal PLOS Global Public Health. A key part of the journal’s mission is to amplify the voices of underrepresented and historically excluded communities and to prioritize equity, diversity, and inclusion at all levels.

Pai urged seasoned professors at the symposium to step aside and encourage their Global South collaborators to take more of a leading role in authoring research papers and leading studies. Afterall, it is often their populations and their patients from which much of the research data is drawn, he said.

Recognizing and elevating underrepresented colleagues is key, Pai said. As an instructor of a global health course at McGill, Pai said he no longer teaches his students about AIDS in Africa. He invites an AIDS expert in Africa to do so instead. Zoom makes it all possible.

In another example of advancing equity, Pai said some innovative institutions like York University in Toronto, encourage faculty to elevate their underrepresented counterparts in studies and make sure their research funding is distributed equitably. This, Pai said, is in sharp contrast to other institutions that insist faculty serve as lead or senior authors on papers to be candidates for promotion.

In closing, Pai said that the Global South must also work to take greater ownership of its public health pursuits for equity to happen. By building and strengthening its resources, the Global South will eventually succeed in getting the Global North to relinquish its power. It is then, Pai said, that allyship will be the only option.

Several times during the Q&A portion of his presentation, Pai acknowledged the innovative work of Yale School of Public Health Professor Sunil Parikh and Professor Yap Boum II, executive director of the Pasteur Institute in Bangui, Central African Republic. Along with student trainees Daniel Hodson and Yannick Mbarga Etoundi, the pair created the Douala Equity Checklist for evaluating global health projects as part of the funding and screening process.

The 20-item checklist aims to force science teams to think about equity during every step of the research process. It also provides opportunities for collaborators in low- and middle-income countries to have a greater voice in determining the methods and goals of a study, the terms of collaborations, and whether collaborations should occur at all.

That sort of innovation is exactly what the Yale Institute for Global Health is designed to encourage, said Dr. Megan L. Ranney, MD, dean of the Yale School of Public Health, which supports YIGH along with Yale’s schools of medicine and nursing.

“In public health and global health, you need to work with others across disciplines,” Ranney said during her opening remarks at the symposium. “This is the space to create new collaborations which ignite and better global health.”

As part of its effort to ignite new collaborations, YIGH announced during the symposium the launch of its signature seed grants for faculty, the Global Health Spark Award and the Hecht Global Health Faculty Network Award. The Spark Award – up to $10,000 – supports YIGH-affiliated faculty as they identify, coordinate, and/or prepare for global health work. The Hecht Award – up to $50,000 – supports YIGH Faculty Networks to promote new research and programs in global health.

Submitted by Alyssa Cruz on April 17, 2024