Module 9. Shifting power through Global South leadership and Global North allyship

0:00 We often talk about global health. This big idea you're working towards health for everyone everywhere. But if you're actually working in health, maybe you feel sometimes the system itself, well, it doesn't always feel that equal. Yeah. That feeling really taps into a huge conversation happening now, often called decolonizing global health, right? Fundamentally, it's about looking at how history, specifically colonialism, has shaped our health systems and uh trying to shift power. Shifting power from the traditional centers, wealthier countries to the global south where so much of the work actually happens. Exactly. Okay. So, it sounds like a clear goal, but why is it proving so well, so incredibly difficult to actually do? That is precisely the question and that's what

0:45 we're exploring today. Looking at a really insightful comment piece by Mahhatukarpai, Shashika Bandara and Katherine Kubutungi. And just to be clear, we're focusing squarely on their analysis here. We want to unpack the systemic reasons they identify for why shifting power is so tough and what they think needs to change. And our aim is to break down their um quite complex arguments into clear points thinking specifically about how this matters to you maybe as a health worker and how these big global dynamics might play out in your work. Okay, let's get into those core barriers that Pi Bendara and Katungi talk about. They're saying it's not just about good intentions, it's systemic. Where do they start? Well, one of the first big areas is the uh the

1:30 wider political contest. They point to nationalistic policies, often from wealthier countries, that actively work against equitable partnerships. Like what kind of policies? Think about strict visa rules. These can make it incredibly hard, sometimes impossible, for leading experts from the global south to even get to key international health meetings. Wow. So literally stopping people from being in the room where decisions get made. Precisely. Or look at the hoarding of health products. We saw it very clearly with co vaccines, didn't we? We certainly did. And more recently with things like EMPOX treatments, wealthy nations secure their supplies first, leaving lower inome countries at the back of the queue. This isn't just bad luck. The authors see it as a real barrier to collaboration and access to resources you might depend on. And connected to that political

2:16 environment is the massive influence of funders, mostly from the global north. Yes, they hold enormous power. Funders often decide who leads major health initiatives, which specific projects get funded, even which health issues become priorities for research, which means they end up shaping what work is even possible or seen as important in your region. Absolutely. It influences the entire landscape. And it's not just governments and funders. The authors also scrutinize institutions we often think of as key players, universities, especially those in the global north, right? They highlight how these universities often benefit financially from global health funds. Their internal structures sometimes make it hard for grant money to go directly to partners in the south who might have lower overhead costs and the cost of education

3:02 itself. That too. High tuition fees can be a huge barrier for talented trainees from lower and middle inome countries wanting to get advanced training. And then there are pressures within academia. Yeah. The way academics often get promoted, it frequently rewards individual success, like leading big grants or getting first authorship on papers, which doesn't always encourage the deep collaborative work needed for truly equal partnerships. Exactly. And it can contribute to situations where researchers in the south maybe don't get the fair credit they deserve for work done in their own countries. Okay. And the final big barrier they pinpoint is something quite current, the push back against diversity, equity, and inclusion, DEI, efforts. After a period where there seemed to be

3:47 growing awareness, particularly around racial justice, efforts to make global health more inclusive are now facing um real resistance politically, institutionally, making it even harder to tackle those deeprooted power imbalances. Yes. And the author stress these aren't separate problems. They're all linked part of a system with roots going way back in history. Okay, so that lays out a pretty challenging set of systemic hurdles. What do payara and kibbutungi propose as a way forward? How do we start moving past these? Well, crucially, they argue it's not just one group acting alone. It needs sort of a two-pronged approach. Strong leadership from the global south combined with genuine active allyship from the global north. Let's break that down. What does

4:33 that allyship from the north look like in practice? According to them, they give concrete examples. For governments in the north, it means changing policies, supporting equitable pandemic treaties, for instance, not blocking them, reforming visa rules, making participation possible. Right. For funders, it means providing direct funding to institutions in the south, allowing fair overheads, trusting local leaders to set priorities. For universities, maybe changing promotion criteria to value partnership work, addressing those tuition costs. Okay. And the other side of the coin, leadership from the global south. What does that involve? It means countries in the south investing seriously in their own health systems, their workforce, their research infrastructure, building local manufacturing for things like vaccines, taking control of the agenda. Exactly.

5:19 Setting their own research priorities based on what they see as important and strengthening networks between countries in the south. They make a powerful point referencing Frederick Douglas that power rarely gives up anything without a demand. It really underscores that active role needed from the global south. Absolutely. But they also add an important layer of nuance. They acknowledge that shifting power isn't just about north self dynamics. Issues within global south countries like ensuring elites don't capture all the benefits also need attention so that change truly reaches everyone. So ultimately transforming global health isn't something that will just happen. It requires both demands for change coming from the south met with real supportive action or allyship from the north. It's a collective effort. This

6:05 analysis by Pi Bandara and Cuhungi really drives home that the inequities we see aren't just random or down to individuals. They're baked into the system by these historical power structures and overcoming them needs that intentional leadership from the south and genuine allyship from the north. So thinking about your own context, how these global power dynamics affect the health work around you, the funding, the priorities, the partnerships. What does understanding these systemic issues make you think about the changes needed big or small to build a truly more just future in global