Interdisciplinarity and Equity in Global Health Research
Elysée Nouvet, Clinical Epidemiology and Biostatistics, McMaster University
Lydia Kapiriri, Department of Health, Aging, & Society, McMaster University
Lisa Forman, Dalla Lana School of Public Health, University of Toronto
Can equity be claimed as a core value of global health research in the absence of equity amongst all players and disciplinary perspectives in the practice of global health? As we gear up for the 21st Canadian Conference on Global Health (CCGH) with its theme of “Partnerships in Global Health”, we would like to propose this matter as one that merits discussion.
Subtly embedded in the last CCGH were a number of divisions between the privileging of: some experts over others, some disciplines over others, and qualitative and quantitative data. The lineup of plenary and keynote speakers, while reflecting a startling lack of gender, racial, and geographic diversity, was dominated by speakers from the “hard” sciences[i]. As global health researchers from a range of disciplines (anthropology, law, medicine and public health), we walked away from these sessions disappointed. While medicine and public health have historically dominated global health, at this juncture it seems reasonable to expect equity considerations to spill over from attention to the ‘subjects’ of global health research to include explicit attention to ‘how’ and ‘by whom’ this research is carried out and legitimized. Persistent hierarchies of knowledge between experts and disciplines highlight the work remaining to transform global health research into a truly interdisciplinary endeavour. These hierarchies also imply that key global health concepts such as equity are externalized as something we do ‘in the field,’ when these concepts can and should also challenge us to rethink how we define, do, and value global health research on our home fronts.
Definitions vary, but the most dominant (if still contested) definition of global health indicates “… an area for study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide,” and : involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration“[ii]. For many of us committed to advancing global health equity through research, the importance of working with a wide range of perspectives has never been clearer. Many factors which have dramatic impacts on health are not in the health sector, including reduced time and ease of travel which has led to the fast spread of infectious diseases, the way food is produced and distributed across national borders which has led to the epidemic of non-communicable diseases and re-emergence of some infectious diseases, the growth of megacities and mega-slums, national debt levels and issues such as climate change, patent law, and global trade. Today’s complex and increasingly trans-national global health problems beg for an interdisciplinary approach[iii].
While global health indicators serve to measure and monitor progress, compare interventions, and, crucially, highlight inequalities, (as we all know) so much valuable information gained in the process of global health research cannot be represented through charts and numbers: we need to focus in addition on ‘stuff’ like social and power dynamics, logistical challenges, ethical dilemmas, and entrenched assumptions or beliefs that may be reflected as dominant norms in law, policies and practices[iv]. These are what Susan Dentzer calls “the devilish details of global health,”[v] requiring research beyond ‘data’ collection and biomedical interventions. For example while HIV care may be provided free of charge to Mozambicans, it might not necessarily reach many of the poor if it is not coupled with a program that addresses relevant cultural beliefs and covers otherwise unaffordable transportation costs to and from clinics[vi]. North American surgical brigades may provide over 500 desperately needed surgeries annually to Nicaragua’s Northern region, but this will not strengthen a grossly underfunded public healthcare system in which decent care is experienced by the majority as the result of luck or privilege, and not a right[vii]. Nor will such interventions resolve limitations placed on government health spending such as those imposed on affordable medicines policies by stringent intellectual property rights within multilateral and bilateral trade regimes, or conditionalities on foreign aid that continue to restrict ‘social’ spending. Several disciplines such as geography, anthropology, economics, political science, law, philosophy, history, and the social sciences are critical to the understanding of the causes and resolution of such complex global health issues[viii].
Ultimately, how we define, conduct and portray global health research raises pressing questions about how we want to define the scope of our accountability as both Canadian global health researchers and as global citizens. If we are serious about achieving equity in global health, we need to assume we still have a lot to learn beyond the ‘hard’ science of global health inequities. We need to take people’s lived challenges, priorities, and preferences seriously, attend to the quality as well as volume of care or technologies provided within particular settings, address the ways targeted interventions connect to and affect the strength, autonomy, and sustainability of public healthcare systems, and attend to the ‘global’ structural causes of domestic health inequities. We need to valorize equity in all aspects of our research: in our questions and methods, but also in how we translate our findings into the ‘meaningful’ and who we routinely anoint (and thus routinely exclude) as experts at our conferences. Equity is about far more than interdisciplinarity, but more interdisciplinary collaboration, analysis, and representation in global health research can affirm our commitment to seeking out, and working with, diverse perspectives. In sum, it seems to us, as researchers working on global health from a variety of disciplinary perspectives, that the time has more than arrived for all global health conferences to prioritize equity in their programming of keynote and plenary speakers by including a far more equitable representation of women and people of colour and by affirming that interdisciplinary work and problem-solving are integral to, rather than novel options within, global health research. If equity is a core value of global health research, this means more than only caring about it ‘out there’ in the field.
[i] For example, out of 14 speakers on four plenary panels at last year’s CCGH, 3 were female (21%), 2 were people of colour/visible minorities (14%), and 2 are currently residing in the South (14%) (these figures are drawn from both the conference materials and personal observations).
[ii] Koplan JP, Bond TC, Merson MH, Reddy KS, Rodriguez MH, Sewankambo NK, et al. Towards a common definition of global health. Lancet. 2009;373:1993–5, emphasis added.
[iii] Skolnik R. Essentials of Global Health (1st Edition). Mississauga: Jones and Bartlett Publishers, 2008;3-8; see also Global Health Europe. Global Health Knowledge Production, 2010. Available at:
http://www.globalhealtheurope.org/index.php/publications/opinion-pieces/374-global-health-knowledgeproduction,(Accessed November 11, 2013).
[iv] See Merry SE. Measuring the World: Indicators, Human Rights, and Global Governance. Current Anthropology 2011:52(3):S83-S95; Adams V. Evidence-based Global Public Health: Subjects, Profits, Erasures In: Biehl J, Petryna A (Eds.). When People Come First: Critical Studies in Global Health. Princeton: Princeton University Press, 2013;54-90.
[v] Dentzer S. The Devilish Details of Delivering on Global Health. Health Affairs 2009:28:946-7.
[vi] See Adams 2013, citation iii.
[vii] Author’s original research 2013.
[viii] Anderson S, Hey JAK, Patterson MA., Toops SW. International Studies: An interdisciplinary approach to Global health. Philadelphia, PA: West View Press,,2013.
Corresponding author: Elysée Nouvet
Clinical Epidemiology and Biostatistics
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