Local and international experts in global health; who's to say?
I was recently invited to review a manuscript in which the terms local and international research were used frequently. This got me thinking about the implicit asymmetries and assumptions in the words we use to describe different activities and people in global health and how that affects who is considered to be practicing global health and who isn’t.
I first came across the term “global health” while doing my masters in global health at the University of Notre Dame. I’d not heard much about global health until I was applying to graduate school for public health. I’d assumed that global health and public health were synonymous but I soon came to realize that people used the term global health to mean something else.
Global Health Unfiltered is now in its second season and we have hosted over a dozen amazing guests with expertise in epidemiology, health diplomacy, biotechnology, pharmacology, and more. Most of them have been from Africa. I’ve found that most of them struggle with the term “global health”. Some outright loathe the term.
“The public health practitioner working to address community health issues in Tamale, for example, is often not considered a global health expert, but a local expert. Why is this?”
Prof. Seye Abimbola, Editor-in-chief of BMJ Global Health, expressed uncertainty about even being in global health. In our conversation, Prof. Abimbola said he believes that public health and global health have similar goals; health equity. However, global health to a certain extent brings public health to an international level. In so doing, the term global health introduces the unspoken assumption that only those who occupy spaces of power globally do global health. These folks, mostly in institutions based in high-income countries (HIC), are those that are assumed to be international experts. The public health practitioner working to address community health issues in Tamale, for example, is often not considered a global health expert, but a local expert. Why is this?
In our most recent interview with Prof. Iruka Okeke of the University of Ibadan, she equally expressed frustrations about the term global health. She describes herself as a global health skeptic even though some would classify some of her work as global health. She believes that global health is really just public health but when people speak of global health what they really mean is health in poor countries. Resource-poor settings in rich countries are not included in this term.
Increasingly, public health practitioners and researchers in low- and-middle income countries (LMICs) are objecting to being considered just local experts. Prof. Salome Maswime, head of the global surgery division at the University of Cape Town expressed this concern in a recent interview in Global Health Now stating that she would like to be listened to “as a global expert, not as a local expert visiting a high-income country.”
Why this objection to the term local expert? This could be because the term local, just like global health v. public health, carries with it certain assumptions. “Local experts” are often viewed to have less “expertise” than those considered global/international experts from institutions in HICs. “Local experts” are often hailed for the value of their “lived experiences” but they would like to be recognized for more than just that. In research grants, researchers in institutions based in HICs are often encouraged to seek the input of local experts with lived experience. In other words, local experts are often seen as second-rate experts to “international experts”.
“We want equal recognition for our efforts in improving access to healthcare. Africa still has not had a Nobel Prize winner in medicine or science, whilst the world celebrates scientists from HICs for their research in Africa. Surely, they didn’t do it on their own.”
In rejecting the “local expert” label, researchers in LMICs are saying that they have had enough! They are in essence demanding to be seen as equals with researchers from institutions based in HICs. They want their expertise and experiences to be recognized and acknowledged in all spheres of global public health, from research ideation, funding, and publishing to implementation. They don’t just want to be consulted for their lived experiences by researchers in HICs when they are applying for research grants. They want to have equal opportunities for those research grants and be truly equitable partners with those from HICs. At decision-making tables, theirs is not just local input but rather expertise in the subject matter that should be taken on an equal or perhaps higher footing than those not based in those communities.
I commend researchers that reject the local expert label and demand to be taken as seriously as researchers based in HICs.
