The challenges of defining global health research

García‐Basteiro, Alberto L.; Abimbola, Seye

doi:10.1136/bmjgh-2021-008169

Cited by 14 publications

(13 citation statements)

References 19 publications

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“…Decolonisation is a critique of the universalisation of the Eurocentric ways of being and doing 4 . As a recent editorial highlights, the ‘they’ who continue to define global health research, in consequence unfortunately also determine the what and the where 15 . The process of decolonisation therefore highlights power imbalances and focuses on how these are maintained or strengthened by existing structures and practices.…”

Section: Decolonizing Global Healthmentioning

confidence: 99%

“…4 As a recent editorial highlights, the 'they' who continue to define global health research, in consequence unfortunately also determine the what and the where. 15 The process of decolonisation therefore highlights power imbalances and focuses on how these are maintained or strengthened by existing structures and practices. Additionally, in the wake of this decolonisation agenda, participatory research -approaches that shift the locus of power towards the local stakeholders 16 -have (rightly) gained prominence.…”

Section: Decolonizing Global Healthmentioning

confidence: 99%

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Realist evaluation in times of decolonising global health

Renmans

Sarkar

Belle

et al. 2022

Health Planning & Management

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Realist evaluation (RE) is a theory-driven evaluation approach inspired by scientific realism. It has become increasingly popular in the field of global health where it is often applied in low-and middle-income countries. This makes it timely to discuss RE's relationship to the emerging decolonisation of global health movement. In this short perspective, we argue that the principles and practices that underpin RE have great potential to contribute to the decolonisation endeavour.Both the focus on the inclusion of local stakeholders and the openness to the rival theories these stakeholders bring to the fore, are promising. However, in practice, we see that a lack of acknowledgement of power imbalances and different ontologies and an overreliance on Western-based theories thwart this potential. We therefore suggest that realist evaluations performed by external researchers, especially in the field of global health, should actively engage with issues of (power) inequities. This is not only the just thing to do, but will also contribute to a better understanding of the intervention and may facilitate the emancipation of the disenfranchised. One way of doing this is through the adoption of participatory (action) research methods, currently underused in realist evaluations. We finally give a short example of an evaluation that combines emancipatory and participatory practice development with a realist approach. The Afya-Tek project in Tanzania has an innovative bottom-up approach throughout the full evaluation cycle and shows the possible

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Section: Decolonizing Global Healthmentioning

confidence: 99%

Section: Decolonizing Global Healthmentioning

confidence: 99%

Realist evaluation in times of decolonising global health

Renmans

Sarkar

Belle

et al. 2022

Health Planning & Management

View full text Add to dashboard Cite

show abstract

“…in which it is undertaken) and the 'who' (the people designing, conducting and using knowledge from research). 8 Salm et al conclude that 'global health' means many different things, and the definitions are conditioned by who defines global health and towards what ends. 9 There are also important questions about the political project behind calls to decolonise global health, and who benefits from it.…”

Section: Introduction Global Health Ethics and Epistemic Justicementioning

confidence: 99%

“…Such concerns are particularly troubling in relation to global health ethics, a subdiscipline of bioethics that studies the ethical issues arising in public health, healthcare and health research in a global or global South context. In this paper, our understanding of global health ethics is informed by existing definitions of global healthi, while recognising that the term global health itself is under discussion,67 particularly with regard to the ‘what’ (the overall purpose/goal), the ‘where’ (the context in which it is undertaken) and the ‘who’ (the people designing, conducting and using knowledge from research) 8. Salm et al conclude that ‘global health’ means many different things, and the definitions are conditioned by who defines global health and towards what ends 9.…”

Section: Introductionmentioning

confidence: 99%

Where is knowledge from the global South? An account of epistemic justice for a global bioethics

Pratt

Vries

2023

J Med Ethics

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The silencing of the epistemologies, theories, principles, values, concepts and experiences of the global South constitutes a particularly egregious epistemic injustice in bioethics. Our shared responsibility to rectify that injustice should be at the top of the ethics agenda. That it is not, or only is in part, is deeply problematic and endangers the credibility of the entire field. As a first step towards reorienting the field, this paper offers a comprehensive account of epistemic justice for global health ethics. We first introduce several different conceptions of justice and decolonisation in relation to knowledge, purposefully drawing on work emanating from the global South as well as the global North. We then apply those conceptions to the global health ethics context to generate a tripartite account of the layers of epistemic justice in the field: who is producing ethics knowledge; what theories and concepts are being applied to produce ethics knowledge; and whose voices are sought, recorded and used to generate ethics knowledge. These layers reflect that the field spans conceptual and empirical research. We conclude by proposing that, going forward, three avenues are key to achieve greater epistemic justice at each layer and to help decolonise global health ethics: namely, understanding the problem, dialogue and structural change.

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“…95 Situated within high-income countries, global health practitioners have largely disregarded the 'global' in global health inequities, seeing them rather only in so-called low or sometimes middle-income countries. 96 These countries are seen as the recipients of global health, with high-income countries on the 'sending side of global health'. 97 As a field of practice, global health has been predicated on differences.…”

mentioning

confidence: 99%

Pregnant Women, HIV, and Clinical Research to Prevent Perinatal Transmission in the 1990s

Rodrı́guez

2022

Journal of Contemporary History

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In 1994, American and French AIDS research showed that the drug AZT reduced the risk of HIV transmission from a pregnant HIV-positive woman to her fetus (perinatal transmission). Hailed as a breakthrough, the AIDS Clinical Trial Group protocol 076 (ACTG 076) soon became the standard of care in the US But ACTG 076 was too expensive for low-income countries where perinatal transmission rates were high; to find a more affordable prevention, the US principally funded studies in several low-income countries. Controversy over whether the short course of AZT studies was ethical, given their different standards of care and use of a placebo, erupted in 1997. These studies remain well known within the global health biomedical literature as illustrating differences between sending and receiving countries. But while rarely invoked within this literature, these two sets of studies have similarities that challenge this hierarchal division: both involved pregnant women as objects of clinical research instead of subjects of clinical care, reflective of the all-too-common focus in global health on disease containment rather than on health care, and both illustrate the ways the focus within global health has been on a solitary biomedical intervention rather than on discrimination, inequality, and poverty within and among countries.

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The challenges of defining global health research

Cited by 14 publications

References 19 publications

Realist evaluation in times of decolonising global health

Realist evaluation in times of decolonising global health

Where is knowledge from the global South? An account of epistemic justice for a global bioethics

Pregnant Women, HIV, and Clinical Research to Prevent Perinatal Transmission in the 1990s

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