A depoliticised global health is one that is disingenuous in its calls for decolonisation and fundamentally crippled in its efforts to bring about true global health justice

About the author:

Debbie 'Dada' Dada recently completed the MSc in Translational Health Sciences at Oxford University (2023-2024). She is a first year PhD student in Public Health and Implementation Science at Washington University in St. Louis.

This past spring, I participated in the Translational Science and Global Health module as a full-time student on the MSc in Translational Health Sciences programme. The module explores how research evidence is used to inform global health practice. We learnt useful approaches for understanding and improving the process of translating research findings to impactful interventions in diverse global contexts.

What We Did

The module centred on complexity—particularly the social, political, economic, structural, and historical contexts that shape both the global health issues we aim to address and the field itself. An overarching theme was decolonising global health, prompting us to reflect on how our work is implicated in systems of power that run counter to the goals of health equity championed by the field.

Seminar-style discussions and group work with students from eleven countries greatly enriched the experience. I learned so much from the brilliant ideas and questions offered by the diverse array of students in the room with backgrounds ranging from health in informal settlements in Sierra Leone to mental health policy implementation in Kuwait to market access for rare disease pharmaceuticals in the UK to primary care in Southern Africa.

The module’s structure was also highly applied. For example, we learned various models for co-creating interventions with communities to address locally-identified maternal and child health challenges in India. Using case studies, we critically evaluated the role of international and local actors in the long-term sustainability of neglected tropical disease programmes in Uganda. We also learned strategies for working with governments and diverse stakeholders to develop contextually appropriate essential health packages in Ukraine and Lebanon.

What Attracted Me

I was interested in the module because I am passionate about global health justice and implementation science. I have worked in global implementation science research for a few years, particularly on equity-focused projects on HIV and TB in Sub-Saharan Africa and North America. As I aspire to have a research career in this area, I was eager to develop substantive knowledge and learn skills relevant to translating evidence into impactful projects.

A Stand-Out Session on Palestine

A particularly powerful session was “Healthcare in humanitarian crisis: experiences from Gaza.” We had the opportunity to learn from lecturers who have trained medical students and cared for patients in Gaza and the West Bank over the past two decades including during the current genocide. A surgeon, Dr. Khaled Dawas, had just returned from Gaza days before his talk and brought raw, first-hand accounts of the impact on patients and medical infrastructure of the ongoing attacks. His stories about the experiences of patients and families were heartbreaking, bringing to life statistics we hear often, such as the UN reporting that 83% of Gaza’s population has been internally displaced by the conflict.

Since the genocide began, over forty thousand individuals have died directly from the violence, more than half of whom are women and children according to the UN. However, this only scratches the surface of the broader health crisis. The destruction of medical infrastructure has had devastating consequences. In terms of maternal and child health alone, the destruction of Gaza's two largest hospitals—which previously delivered 34,000 babies each year—has left thousands to give birth unattended in tents, settlements, and overcrowded shelters. The situation has also severely impacted healthcare workers, many of whom have been targeted, and medical students whose training has been derailed.

While improving strategies for providing care in such human-made disasters is crucial, the session underscored the importance of critically engaging with structural and political forces that underpin such crises. A depoliticised global health is one that is disingenuous in its calls for decolonisation and fundamentally crippled in its efforts to bring about true global health justice. Indeed, if the field of global health is to live up to its claims of championing health equity and the right to health for all, this requires us as individuals and institutions to move beyond rhetoric and engage in liberatory praxis in solidarity with oppressed peoples everywhere. In my view, advocating for a ceasefire and a free Palestine is just as central to promoting health equity as determining the best implementation strategy for delivering a biomedical intervention in this context.

A Few Takeaways

Two ideas that have stuck with me since the module are: 

1. Consider the limitations posed by Eurocentric conceptualisations of health that dominate global health research and practice on our ability as translational health scientists to use evidence to improve health in ways that align with the priorities of our communities of interest. A central goal of translational health sciences is improving health through studying the human and social factors that influence the uptake of research and evidence-based practices, but how we define the goal of improved health has important implications. Typically, interventions are deemed 'evidence-based' only for their ability to improve standardised measures of physical and mental diseases, which implicitly operationalises health as the absence of these diseases. But there are many ways to conceptualise health and therefore many ways to determine an intervention’s value for improving health. For example, Aboriginal Community Controlled Health Organizations form an alternative model of primary healthcare delivery in Australia which embrace a health model that encompasses connection to body, mind, kin, community, culture, land and spirituality. This approach informs how evidence is marshalled in order to align practices with the priorities of Indigenous and Torres Strait Islander populations and has led to great success. When aiming to achieve holistic health outcomes decentred in Western medicine, what types of evidence and whose voices might need to take greater priority? I hope to continue learning from Indigenous scholars and community members on the bidirectional relationship between how we define health and how we determine what evidence (and corresponding approaches to research) are most useful. 
2. Consider the potential role of systems approaches in translational health sciences research. Many of the health issues we aim to address can be framed with varying levels of complexity. We can focus on the barriers to addressing the issues that are most proximal to the patient or specific to a certain disease or we can zoom out and focus on the multitude of factors within a system interacting to generate and sustain the problems. In zooming out, we see many of the issues we aim to address are deeply embedded in structural, political and historical determinants of health. This means that isolated, discrete, short-term interventions that only target individual-level barriers or one-off projects on 3-to-5-year grant cycles are rarely sufficient. Addressing such complex issues requires long-term collaborative efforts that put communities at the centre—an approach that oftentimes requires challenging structures within academia and global health practice. When confronted with community-identified problems that dominant approaches in our disciplines are ill-equipped to address, what do we do? Work within the existing structures to implement more transformative interventions? Obscure the complexity and partition the problems into boxes that our disciplines are equipped to handle? Or stretch the very bounds of the disciplines themselves? I hope to continue learning from scholars applying systems thinking to global health problem-solving.

Closing reflections

Despite the heaviness of the topics explored, I came away feeling more energised and inspired than I had expected. Facing these challenges alone can feel daunting, but the module provided a space to connect with an intergenerational and interdisciplinary community of practitioners, scholars, and new friends who are committed to tackling these complexities head-on. I left with a real sense of hope and clearer direction for how I will use my career to address challenges at the nexus of global health and translational health sciences. I can’t recommend the module highly enough.

For further engagement, watch the recording of the talk 'Healthcare Within a Humanitarian Crisis: Experiences from Gaza' on the Oxford University website here.