Translating Theory Into Action: Are we lacking competencies, or just failing to recognise systemic power structures?

By Molly O’Meara, Nashwinder Kaur and Hajer Hadi

A constant struggle within the field of global health lies in bridging the gap between what we learn at an institutional level and what we practice in our work. On the 8th and 9th of November 2019, the Swedish Network for International Health (SNIH) hosted a 2-day conference at Lund University, Sweden, to address this crucial topic. The SNIH annual conference is “an opportunity for students to network and learn about the myriad of ways that a public health career can manifest itself” with the theme this year being “Global Health: Translating Theory Into Action”.

Having attended conferences in the past that failed to gather a diverse group of panelists, the diversity of the panel discussions both days were very well-received. The first panel discussion was about the prioritization of resources and the translation of research to “other” settings. It featured thought-provoking perspectives and solutions including stronger collaborations, more intensive listening to the beneficiaries, and greater appreciation of cultural perspectives. On the other hand, the second panel discussion went in circles about translating theory into action, and attendants were left with no concrete answers. Participants were eager to hear some success stories from collaborative research and implementation, yet it remained a very diplomatic conversation. The responsibility was instead thrown over to students, who are not in a position of power to determine which kind of research matters most.

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The SNIH annual conference took place in Lund in November 2019. All photographs by the authors.

The traditional global health domains of disease burden, health determinants and frameworks are well-covered in many global health curriculums, but students still lack the capacity to harness acquired research knowledge into field application (see Sibylle’s presentation in the linked folder). The ability to innovate – using tools such as technology to combat antibiotic resistant bacteria with antimicrobial peptide plasters, or e-health to enable greater access to healthcare through online care or tele-medicine – still receives less focus in classrooms. Another key but often neglected discussion in global health institutions is the translation of research findings from the Global North to the Global South. This consequently perpetuates the existing power dynamics that dominate the field of global health. Furthermore, the roots of colonialism and our current unequal power structures are not well-covered or reflected upon within the classroom.

So, are we really lacking competencies in translating theory into action or are we simply not acknowledging the systemic power structures posing barriers to doing so?

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From left: Moderated by Florence Nordman, Martin Andersson, Alexander Chikonga, Fatou Wurie

One of the fundamental issues raised by Fatou Wurie, an emergency specialist for UNICEF, was related to this question: “The reality is that this is about power”. She expressed that the problems faced today in the field of global health will not go away unless we accept this power dynamic and make a thorough attempt at restructuring the entire system. We can no longer continue this charade of white saviorism: our habit of giving with one hand and taking with the other, our pretence that health care inequity will eventually diminish as we continue to tackle it within a structure based on a system of colonialism and oppression.

But how can we go about repositioning the power? Both Fatou Wurie and Alex Chikonga expressed that repositioning the power, in essence, is about repositioning those in need at the centre of every intervention. This might seem obvious, but in reality, it is not what is happening. Those in need should be the ones to define what they need, when they need it, who provides it, where they provide it, and every other detail. We need to acknowledge that we do not know what is best, as this mindset is inherently colonial. The people who know their needs best are those at the receiving end. Thus, global health students should primarily be learning about communication and collaboration skills in the classroom. We need to listen first, then act – not the other way around.

Furthermore, gatekeepers are especially crucial when it comes to repositioning the power. According to Fatou Wurie, “We are at the mercy of western researchers who have the power to determine what research matters… They come to low income countries, use people as subjects, and then the knowledge stays in the global north.” Despite the initial intention of altruism, the field of global health still reflects its colonial history, and advances with neocolonial tendencies. The current relationship between the Global North and Global South needs to shift into a field that is founded on finding new ways to support local efforts already in place.

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From left: Moderated by Abeer Salah Ahmad, Caitlin Pley, Dr. Christian Fabricius, Mona Kiwan, Sibylle Herzig van Wees

Inevitably, what we teach in classrooms will eventually impact the world, and this connection between theory and practice is why we, academics and students alike, have a responsibility to critically analyse how we teach global health. By failing to adequately teach “real-world” settings and the dark histories which shape them, we run the risk of perpetuating colonial narratives amongst the next generation of global health professionals. Senior lecturer Sibylle Herzig van Wees stated that “You need to come up with the solutions as students of global health. Challenge your programmes. Be an active student and challenge your education.” She also emphasised that in order to address and respond to health problems that transcend national borders in the world, we need to start challenging our programmes and work towards a local global health as well. We need to prioritize the movement away from traditional international health and instead focus on local empowerment and engagement of communities. Yet, the idea that students are the ones responsible for changing the system, is perhaps an unfair and unrealistic burden or challenge. Academic institutions, providing the education to future global health practitioners, also need to step up and take the lead in challenging these power structures.

The paucity of translating theory into action is not a result of a lack of understanding. Rather, it is a result of a failure to challenge the power structures we are working within and a determination to seek solutions within a broken system. This powerful take home message from the conference illustrates how the structure of  global health is in need of a complete reshaping. As participants, we have come to recognize the post-colonial traits ever present in how we study and practice global health. Thus, there is a need to use this information to frame a new perspective for the field of global health that can transform our thinking and actions. In the words of Fatou Wurie, “We are at a point in the world where we can no longer do business as usual.”

 

 

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