Ruth Habte is a medical student in the Class of 2019 at the University of Manitoba
I have been privileged to take part in implementing global health programming while in medical school, both at my own school and across the country. Throughout this time, I have often been prompted to answer the infamous question: “What is global health?” I have also encountered the misconception of global health being synonymous with international health. Based on my learning and experiences, I have come to define global health in my own terms.
While global health is an incredibly broad field, the cornerstone of global health (in my opinion) is attaining health equity for all people. That means that a person with less privilege in life should be afforded greater means to reach the same health outcomes as those with more privilege. If we think about this locally, we know that income and social status remain some of the largest determinants of health (1–3). Global health is about understanding that patients with low socioeconomic status are at risk for worse health outcomes, and advocating for policies to bridge the gap between what is currently provided and what will afford better health outcomes.
In another context, global health is about ensuring marginalized minority groups feel safe seeking care in a system that may not have been designed with their health in mind. For example, the majority of our health care system is designed for cis-gendered, binary, heterosexual people. As such, we need to be cognizant that this does not represent our entire population and actively take steps to ensure we are acting as allies. This includes educating oneself on terminology, asking for pronouns, demonstrating one’s allyship through actions, and supporting queer* colleagues. Another example is providing culturally safe care to Indigenous people and recognizing settler privilege. This includes educating oneself on Canada’s long history of cultural genocide and the ongoing systemic racism that seeks to oppress Indigenous people, as well as committing to reconciliation.
When I think of global health abroad, the same principles of health equity come to mind. Global health projects should always seek to provide the best care possible with the given resources, and to do so in an ethical and sustainable way. In providing care, we may also have to enlist the help of a local translator. We should always ensure that we are giving more to the community than we are receiving, and that the community actually wants us to be there. Before going abroad to provide health care, we should examine our own motivation for doing so and ensure that we are not participating in voluntourism (i.e., going abroad for one’s ego). We should also ensure that we learn about the community we are traveling to prior to arrival, including their traditions and values.
As a future MD, I am in a position of privilege. Global health is about recognizing this privilege and using it to create an equitable system for those with less privilege.
* Queer is a reclaimed term used as an umbrella adjective for those from gender and sexually diverse populations.
- Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;Spec No:80-94. Review.
- Phelan JC, Link BG, Diez-Roux A, Kawachi I, Levin B. “Fundamental causes” of social inequalities in mortality: a test of the theory. J Health Soc Behav. 2004 Sep;45(3):265-85. Erratum in: J Health Soc Behav. 2005 Mar;46(1):v.
- Flaskerud JH, DeLilly CR. Social determinants of health status. Issues Ment Health Nurs. 2012;33(7):494-7.
“the majority of our health care system is designed for cis-gendered, binary, heterosexual people…”
On the contrary. The majority of our health care system is designed for human beings, inclusive of all sharing certain standard physical configurations, pathology, treatment. That is to say : everyone.
“educating oneself on Canada’s long history of cultural genocide and the ongoing systemic racism that seeks to oppress Indigenous people”
This is a truly absurd characterization of Canadian society, especially the “ongoing” part. No one in the present generation is responsible for the wrongs we are attempting to right. Moreover, there is an open question as to whether the indigenous population has not enjoyed an enormous objective gain, considering the increase in native life expectancy, (from a time when one severe famine could eliminate up to 80% of a local population, to today, when natives have access to all the advantages of modern life) Just as a thought experiment, take a look out the December window, right now, and think how nice it would be to live outside in a tent with nothing but fire to keep warm.
But that is neither here nor there. The true absurdity lies in the proposed solutions to address the alleged collective responsibility of the Canadian majority : The victim pecking order runs into serious trouble when we realize how many socio-economically handicapped “settlers” there are. White privilege is extremely thin for the vast majority. Nothing at all when compared with upper-class members of “oppressed” groups.
In short, the racist and sexist, zero-sum agenda of promoting LGBT and Natives at the expense of the bulk of Canadian population is just plain wrong.
“misconception of global health being synonymous with international health”
If I provide a dollar to global health, I expect it to serve outside the country. That is why we inaugurated global health to begin with : to assist other people in other lands with our amazing technology.
It is a horrible and almost incredible Orwellian perversion of that original positive purpose, for academics, now, to attempt to provide a rationale for embezzling those scarce resources, to use them, instead, here at home, in the support of what are surely the most heavily funded domestic Canadian agendas of all time : LGBT and Native rights.
In short : All of this is amazing and unconscionable.
Gordon Friesen, Montreal