‘Manufacturing consent’ in global health education and research: February’s edition of the Decolonising Global Health blog series

Back in the late 90s, I embarked upon my south-to-north migration journey to join an engineering graduate programme. During this time, I began to critically question the skills I had learned during my 16 years of education in my beautiful native land of Perú. In hindsight, this may have been an exercise in self-reflection to overcome my well-founded fears about going to America, one of the most powerful, wealthy and technologically advanced countries in the world. A portrait America arrived to us – people from the Global South – only via local and printed media.

When I became a real engineer, I interacted with industrial workers ('obreros') on a daily basis. These obreros lived and worked in neighbourhoods located in the outskirts of Lima, a truly impoverished area where resource-poor but hard-working families live. I witnessed first-hand how people gave everything to earn a living while working in appalling conditions at low minimum wage.

Fieldwork with Partners in Health team; Carabayllo, Lima, Perú (2012)

Later as a graduate engineering student in the US, I was given a seemingly simple assignment: to video record poultry processing plant workers' daily tasks at a large US East Coast facility to conduct a job analysis. That fieldwork experience connected the two worlds I had known up to that point (Perú and America), where I saw similar realities for thousands of workers. Both work systems had disempowered human beings with no autonomy in their jobs, and both realities had people exposed to inhumane and unsafe conditions of work – in all honesty, a disposable workforce. This experience had a profound impact on me.

Unfortunately, such conditions haven't changed for the Global North or the Global South – at least not at the pace required in order to create healthy and prosperous working conditions for all.

Photo Credit: John D. Simmons/The Charlotte Observer | OXFAM report

Around this period, I was hand-delivered a book by my PhD supervisor, Professor Michael Smith, a renowned scholar engaged in workers' rights. 'Working: People Talk About What They Do All Day and How They Feel About What They Do', by Studs Turkel – a book widely recognised as one of the most important works of oral history to be published. Using my newly acquired skills as a trainee industrial and systems engineer, I began to examine – or tried to examine – the systemic nature of the many deep-rooted injustices in our society. To me, interconnectedness is what centres the core of what systems are, with elements and purpose following. A systems perspective is truly needed to be able to reframe and review forgotten (or abandoned) stories in global health.

Gradually over time, the knowledge I gained began to make me critical of the power structures in both the Global North and the Global South. It has taken me 20 years to be able to begin writing about it, bringing together the two worlds and adding context from both my personal and professional life.

As I write this on 20 February, World Social Justice Day, at a renowned academic institution, sitting in a privileged seat, the seat of Global North academia, I invite you to join me in the examination of how power dynamics ('Nkali') shape what work we do and how we do it.

A recent vivid example could perhaps offer us a practical step. In one of my first MSc in Global Healthcare Leadership classes, a management professor asked us to guess which company is known as the most successful in human history. While names of tech and pharma companies were offered, we failed to answer correctly. We then learned it was McDonald's! This is due to its massive economic success as the largest American multi-national fast-food chain. Instantly, I began to feel some discomfort which felt justified due to my experiences with oppressed workers in both Perú and the United States.

I respectfully disagree with the economic narrative behind the success of Global North corporations. The evidence of inhumane working conditions, working rights violations and union rights limitations is clear. I am and have been highly aware of the danger of the single story of economic power and success, most importantly in relationship to health – to global health.

I began reflecting on our role in allowing or impeding the process of 'manufacturing consent', not in the media context as described in Noam Chomsky's masterpiece, but more broadly. Specifically, I considered how we develop independent thinking and critical perspectives on how information and knowledge is produced in global health research and practice. We will dig into unfair knowledge practices next month.

Respectfully disagreeing and thinking critically, whether it be inside or outside of the classroom is an important first step in acknowledging and dismantling inequities. What if the Oxford professor had experienced what it is to work at a poultry processing plant – even from a distance? What if he had spoken to workers about their attempts to unionise? What if he could have watched a video of Peruvian industrial workers fighting for a better quality of working life? Would the outcome be different?

Relationships are the defining feature of the human experience. It is equally important to remember that the human factor – the workers, the patients, our students – not only have a voice, but their voices matter! Let us try to listen to them as we reimagine a global health system that is fair, efficient, and most importantly one that prioritises health creation over wealth creation.

Let's get into good trouble. ¡Hasta pronto!