Of Power & Privilege
A couple of days ago, I hit a tiny milestone of a full year working in global health. Seeing that this is a global health newsletter, I suppose I should commemorate the moment by spending some word count on it (since there won’t be any fireworks or parties for me).
But before I cogitate on what I’ve learned over the past year, let’s dial back further. I started my career as a medical doctor many moons ago, plying my trade in public hospitals, where it was underequipped and underfunded. There, I worked with my patients directly, and personally, healing them one disease at a time. I appreciated this deep relationship with my work but therein lies the problem as well. As I understand more about the social, economic and political barriers in healthcare, the more I felt I was trying to push against a wall.
I moved to public health several years later, with the hope that I could impact more people (or patients). Working in hospital management gave me that opportunity, though it increased the distance between me and my patients, essentially losing that deep relationship I cherished. But I soon found out that working in a system isn’t enough either, because systems are often bound by the chains of policies and politics. So I figured I needed to work with, and sometimes, against the policies.
So with a bit of luck (and probably a pandemic), I got myself a job in a global health institute, now with the grand aim to reduce health inequities on a much wider scale.
So what’ve I learned in these twelve months?
I’ve learned global health is an intersection of many aspects of health. Ranging from healthcare, politics, education, and socioeconomics to culture, it’s a complex machinery of interdependent sectors and expertise.
There are also many players in the global health arena, but only a handful hold the power. And this power is immense, it can be used to redirect focus and resources, especially when resources can be scarce after dividing the pie. Building relationships is key to accessing this power and if you can gain currency into the corridors of global health power, you too can redirect some resources to do good.
That said, with all the inequities and injustices in the world, there are many ways to do good. I resent the word ‘opportunity’…the ‘opportunity to do good’ as if the situation must be favourable for us to do good in global health (I can be pedantic about language at times). But I’ve digressed a little here.
If we recognise power is central to global health, then being in global health itself represents an opportunity for introspection. An opportunity to ask ourselves, who are we serving when working in global health? With the high stakes involved, when you strip the work to its bones, you then realise everything apart from the focus of the work is just noise. Everything else is just a distraction.
So I’ve learned in the past twelve months that global health is about power and privilege. And it’s our duty (yes I call it a duty) in global health to redistribute this balance of power from the handful, to give back the voice to the vulnerable and oppressed.
Paul Farmer, a giant in global health, who died one year ago said this in his book, Pathologies of Power:
“In this increasingly interconnected world, we must understand that what happens to poor people is never divorced from the actions of the powerful. Certainly, people who define themselves as poor may control their own destinies to some extent. But control of lives is related to control of land, systems of production, and the formal political and legal structures in which lives are enmeshed. With time, both wealth and control have become increasingly concentrated in the hands of a few.”
In Paul Farmer, what I admire most is his unwavering conviction to do good, that stubbornness to never accept anything less and the tenacity to always pursue what he believed in. I’m a greenhorn in this field, and I’ll probably never be a Paul Farmer, but I think striving towards that ideal is important. It’s what the ethos of global health should be. It must be.
I don’t know if I will ever live to see the impact of my work now. I probably won’t. But maybe it doesn’t matter. I am not looking to write in journals or to be written in books. Knowing that I’ve put my effort into steering the ship towards that direction is perhaps good enough.
I know it’s good enough.
If you made it this far, thanks for reading. I’ve decided to keep the publishing time as Sunday night here at +8 GMT. I seem to be most creative on Sunday nights. Or maybe just pensive because it’s Monday soon. Till next time.