The global health community is committed to addressing and ending health inequities to improve the health and well-being of all. But what if the “global” conferences and forums where such health inequities should be discussed are themselves perpetuating inequity? This article takes a closer look at the World Health Summit to discuss how inclusive these forums are.
The first joint World Health Summit (WHS) co-organized by the World Health Organization (WHO) took place in October in Berlin, Germany, with 3 days of panel discussions, keynote speeches and workshops.The Summit aspires to be the world’s leading international, inter-sectoral and inclusive conference on global health that will set an agenda for a healthier future. But is the WHS – and global health conferences in general – truly inclusive? Who attends global health conferences? Where are the conferences held? And who is given a voice at such events? Using the case of the WHS 2022, I’ll take a closer look at these questions.
Before I start, I’d like to clarify some of the terminology I will be using throughout the article. According to the World Bank, countries can be classified low- and middle-income countries (LMICs) or high-income countries (HICs) based on the country’s gross national income (GNI) per capita. Here, I will also use the term Global North to refer to the nations in North America, Europe, Australia, and New Zealand, and the term Global South to refer to countries in Africa, South America and Southern Asia. Although I will use them interchangeably, the terms are distinct in nature and have different connotations.
Who attends global health conferences?
The WHS brought together more than 400 speakers, ranging from medical professionals, ministers and civil servants, CEOs from industry and civil society, and high-ranking dignitaries. The organizing team affirmed they were mindful to ensure discussions at WHS were not one-sided and included speakers from every region of the world to achieve strong Global South participation. Yet, just by looking at the list of speakers, it comes to light that the reality was different. In fact, out of the 400 speakers, nearly 200 represented countries in the Global North, around 60 countries in the Global South, and 50 international organizations.
Unfortunately, the under-representation of attendees from the Global South at WHS 2022 is just one of the many cases of ‘conference inequity’. The opportunity to attend most major global health events remains in favor of professionals from HICs, as multiple systemic barriers continue to hamper the attendance of representatives from LMICs at global health conferences, which are often held in the Global North. The biggest barrier is financial, relating to costs of traveling and attending the conference itself, such as registration, food, accommodation and transportation costs.
Participants from LMICs also often struggle to attend conferences due to visa restrictions in the host countries. In November 2018, 17 female researchers (14 from sub-Saharan Africa and 3 from Asia) were unable to attend the Women Leaders in Global Health conference organized by the London School of Hygiene and Tropical Medicine in London due to visa issues. More recently, in July 2022, the AIDS conference in Montreal came to an end with a session with empty chairs for the speakers, as the panelists from LMICs were not able to attend physically due to visa denials or delays.
And even when visa restrictions can be overcome, academics and professionals from the Global South too often endure humiliation and discrimination while attemping to travel in their official capacities to conferences held in the Global North. This was sadly the experience of Dr. Ahmed Ogwell Ouma, the acting director of the Africa Centres for Disease Control and Prevention, who returned home after being mistreated by German immigration authorities upon arrival in Berlin for the WHS 2022.
Why are global health conferences held in the Global North?
The WHS in Berlin and AIDS conference in Montreal are only a few examples of the major global health events held in HICs. In fact, more than 96% of global health conferences in the last three decades have been held in HICs or MICs, with only 39% of the delegates were from LMICs.
This is in spite of the fact that LMICs represent 5x the population in HICs and experience the majority of the global disease burden, as well as that the majority of global health programmes and interventions target countries in the Global South. So, why are international health conferences overwhelmingly located in and managed by institutions in HICs?
Some have argued countries in the Global North are more equipped for high-level events and that countries in the Global South do not meet the standards required for such events. However, numerous conferences and summits have been successfully held in LMICs and have achieved a high level of participation of attendants from such countries. The 2016 AIDS Conference in South Africa is an example of a forum which reached 60% delegates from LMICs. Holding conferences in the global north could rather be seen as a logistical convenience for the 98.5% of global health actors that are headquartered in high-income countries. Moreover, the countries hosting global health conferences are often among the biggest donors to global health programs and interventions. Indeed, the host country of the annual WHS, Germany, is also currently the largest donor to the WHO.
Who speaks at global health conferences?
The power of donor countries and institutions is not limited to determining the location of global health conferences and it becomes clear when we scrutinize who is given a chance to talk on stage at such events. The list of speakers at WHS 2022 revealed the power and influence non-state actors, such as the Bill and Melinda Gates Foundation and the pharmaceutical industry, have in shaping the global health agenda and architecture. In recent years, the Gates Foundation has emerged as one of the biggest financial contributors to the WHO. At the WHS, it was the only institution with more than 1 speaker (Bill Gates and Gates Foundation CEO Mark Susman). Its inflated – and distorted – influence in the global health landscape also became apparent in the donor pledges at the end of the conference. Among others, donors pledged US$ 2.6 billion more funding to the Global Polio Eradication Initiative on the closing day of the WHS . Almost half of this funding (1.2$ billion) came from the Gates Foundation alone. It is not unusual or surprising that the Gates Foundation is devoted to funding specific global health portfolios and vertical programs, rather than funding horizontal delivery of health programs. Its contributions to the WHO are entirely specified voluntary contributions, that is, contributions that are ear-marked for specific programmatic areas and/or geographical locations, such as the Global Polio Eradication Initiative.
But this is not an issue of the Gates Foundation alone. Most of the WHO’s funding comes from specified voluntary contributions, with only less than 20% of the WHO’s budget coming from regular fees paid by Member States. In this way, countries and donors in the Global North continue to drive the global health agenda by financing programs and initiatives that align with their goals and values rather than to the needs of the target countries and populations.
Why is underrepresentation of LMICs at global health conferences an issue?
The under-representation of LMICs at WHS is not only an issue of equity and inclusion but it’s also a huge loss to the global health discourse. By bringing together a diversity of attendants and speakers at global health conferences, we can ensure multiple perspectives are taken into account, avoiding useless one-sided debates. The meaningful participation of representatives from LMICs ensures the needs and realities of LMICs are reflected in global health action. Obviously, with too few participants from LMICs, the voices of such countries are often not heard and their needs are not brought forward at the decision-making table.
Undoubtedly, the issue of under-representation of LMICs points to bigger power inequalities in global health. All aspects of global health, including conferences, decision-making, research and financing, are dominated by and designed to benefit the Global North. Conference inequity is a symptom of the deeper issues of systemic racism and of the neocolonial economic, political and cultural influence of former colonial powers.
A way forward for global health conferences: a decolonizing perspective
The WHS, and global health conferences in general, are important platforms for exchanging knowledge, setting the global health agenda and for making critical decisions about areas of priority for action. They are also spaces for fostering collaboration, as well as for personal and professional growth for attendants. As such, the WHS needs to be an inclusive space for all.
The global health community must rethink the ways meetings are organized and the venues for international conferences are chosen to ensure true inclusion and equity. Travel scholarships and mentorships programmes should be included to enable stakeholders and professionals from LMICs to participate. But removing financial barriers is not enough. It is time to relocate all future global health meetings and conferences to visa-friendly countries in the Global South to facilitate attendance from LMICs and provide an opportunity for joint mobilization and collective action. This would reaffirm the global health priorities and encourage a dialogue and closer connection between decision-making countries in the Global North and the communities targeted by many global health programs.
As global health professionals, we have the responsibility to make the changes needed to create an inclusive space for conversation and decision-making. Achieving equity in global health requires us to go further and tackle the power dynamics that stem from the colonial legacy of global health to effectively reshape the whole global health system. This is no easy task and requires sustained effort. Addressing the issue of conference inequity is a first step to move from rhetoric to action to decolonize global health.
So, next time you are invited to attend a global health conference or you read about one, I invite you to start asking the uncomfortable questions; Where is the conference held? Who is attending? Who is speaking? Who is not speaking?, and question your own privilege; Did you have to apply for a visa to attend the conference? Could you afford traveling to the location? and share your experience with others at the conference and online.