“Can we achieve equity in global health research and education?” Epidemiologist shares perspective

University of Cape Town: That “global health” is dominated by a few affluent countries highlights an inherent contradiction of the term. The Global South, despite representing 85% of the world’s population according to an Al Jazeera source, continues to be systemically excluded from worldwide policy-making decisions, with damaging consequences. But this can be remedied. This was the essence of the keynote address by Professor Madhu Pai, Research Chair in Epidemiology and Global Health at McGill University in Canada, at a seminar for Health Sciences students and staff on Tuesday, 12 December 2023, titled “Can we achieve equity in global health research and education?” 

Born and raised in India, Pai studied medicine in his native land and now lives in Canada. The Chair of the Department of Global and Public Health at the McGill School of Population and Global Health, who holds an honorary professorship from UCT’s Department of Medicine, spoke with energy and compassion about the injustices experienced by the Global South at the behest of wealthier nations (“Global North”).
 

The shortcomings of global health 

Pai was candid about global health failing to deliver equity. Structurally, the system is broken, he asserted. As a case in point, HIV medicines took the best part of two decades to arrive in South Africa, by which time millions of people had already been infected and died. Moreover, Africa was last to receive Mpox vaccines, whereas in Canada, the day the vaccines were rolled out ordinary people could access them immediately. “When something fails once, you can call it [a] fluke [or] chance. But if it happens [multiple times] there is only one explanation for that: it is designed to fail”, Pai soberly remarked.

“Life and death decisions are made in the Seattles, the Washington DCs, the Londons and the Genevas”, he said. Moreover, “70 to 80% of all global health major donor money stays within [these high-income countries]. Eventually, it trickles into UCT.”
 

Power imbalances and gatekeeping  

The North-South power imbalance is evident in a pattern of systemic discrimination against African nations, including the denial of visas to attend international conferences. Pai cited an AIDS conference in 2022 that was held in Montreal, Canada, and how the conference was “devastated” because most African delegates could not attend due to their visas being refused.

Similarly, a 2023 TB conference held in Paris, France, was hamstrung by the lack of African delegates. With Africa bearing the burden of these diseases, the prevention of African input severely restricts the productivity of these debates. 
 

Shaping the future 

Pai’s answers to the question posed in the title of his talk suggest it is possible to reach equity if regions like Africa take control of their futures. In the face of current world circumstances, “Africa must learn to be self-reliant…not asking for permission from anyone,” Pai asserts. For instance, African nations could manufacture more of their own diagnostic tests. Right now, not even 5% of diagnostic tests are manufactured in South Africa. He expressed concern that if Africa does not draw on its own strengths to solve health challenges, when there is another global health crisis, Africa will again be marginalised.  

A bleak reality is that the global health field is overwhelmingly dominated by male academics, as is evident in journal publication houses, for example.  Pai proposes greater male allyship in the appointment of more women editors, as well as diversifying editorial boards to challenge the status quo in global health.  

Speaking about training students, Pai believes that “a massive shift is required” in how the Global South is taught in the Global North, including whose opinions and work are foregrounded on certain issues.  Furthermore, he reminded students that “global is local”; students in high-income countries should not neglect their own local marginalised communities. “If you ignore inequities within your own country, you look very disingenuous going and trying to do equity work somewhere else.”
 

Panellists

His well-anticipated address generated lively contributions from the audience and a panel of experts that included Professor Salome Maswime (Head of Global Surgery at UCT), Professor Tulio de Oliviera (Professor of Bioinformatics at the University of KwaZulu-Natal and Stellenbosch University), Professor Leslie London (Chair of Public Health Medicine at UCT), Zahra Parker (fourth-year UCT medical student), Associate Professor Sipho Dlamini (infectious diseases specialist at UCT) and Fatima Hassan (South African human rights lawyer and activist).