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Warning! The Age of Global Health Confusion

By Shakira Choonara
on October 23, 2018

I first thought of this issue on the 11th of October, so I got slightly delayed, but I know (from personal experience) that there is a recovery period needed for many IHP readers post that wicked Health Systems Global party in Liverpool. So I bet you won’t mind the delay. Being also a victim of flu, I’m hard at work trying everything besides antibiotics of course – cognisant of the global wave of antibiotic resistance! #globalhealthstartsathome

Working in different spaces in recent years, but also wanting to strengthen the health system overall, I have observed just exactly how fragmented our work is and the types of silos which (still) exist. If you don’t like the cold hard truth, perhaps you should stop reading now : )

So, we have our health systems cliques, our gender equality circles, the HIV world, the non-communicable disease advocates (hee ha, yeah we’re beating #NCDs) and well, the list is endless. Now, I have definitely learnt a lot being around in these different areas of our health systems but the question I keep hitting my head against the wall on, is how on earth does all of this come together? Our health systems are so diverse, from the pharmacist to the human geneticist (yep it was great addressing all of you recently), how do we bring it together and more importantly, when will we begin to do so?

Yes, I hear some of you saying (/chanting), “UHC, UHC!” and the even more holistic types among you, “SDGs, SDGs”!” but sorry, that won’t cut it. Just check your Twitter feed.

What sparked this short reflection? Well, Moeketsi Modisenyane (South African Department of Health), who once at a conference said that as a policy-maker it was difficult to gauge what to do from research presentations and recommendations; most of us create politically correct, soft, probably never to be implemented recommendations (yes, I am guilty too).

Now just imagine if you were a policy maker this month on social media, specifically on the 11th of October. I am not joking, we had in just one day, THREE critical issues, I repeat: ALL IN ONE DAY. Tweeting separately or running digital campaigns with absolutely no overlap or thoughts on cross-cutting issues (well, I bet so) and well pushing our individual priorities was the most important, right? A day before (10th October), we raised issues around World Mental Health Day, followed by 11th October and, in no particular order;

Now I don’t know about you, but I thought OMG! I am passionate about all of these issues (one of them is my bread and butter too, important to disclose #justsaying), I have so much to say on each issue, but being a tad tech savvy I also know that if I post on each issue, I will be confusing my followers but hey, more importantly than my following, have we all thought about how confused this can make decision-makers?

Then of course, being an activist comes with individual action first, so I attempted to push some critical thinking and began tying up these issues: survivors of gender-based violence (GBV) require mental health services in our systems, those who are forced into child marriages rarely have the psychosocial support either. Obesity is inherently interlinked to stigma and particularly tougher on one gender (guess which one), which is also linked to this year’s World Obesity Day theme, “weight stigma”, but hey, that’s in turn also tied into mental health. Let’s turn to the “blind girl”, the experiences and double oppression there (#intersectionality).

This is just a first and by no means perfect attempt, at least in my brain, to start thinking beyond fragmentation and silos to cross-cutting issues, the importance of alignment of our programmes, our thinking and our messages, particularly to work through this “Global Health Confusion” which has been created and which we are (still) creating, in spite of the (presumably more holistic) SDG health era. So let’s not stop this thinking, add on your thoughts! And don’t ride the waves, we just surfed HSG #HSR2018,  #WorldFoodDay, Pink Month for Breast Cancer, (World Health Summit) #WHS2018 and now we’re surfing full speed towards #AlmaAta40 #Health4All and please do not forget the Ebola crisis in the Democratic Republic of Congo !

All of this is equally important, but let’s face it, you may get a tad confused with all the worthy issues mentioned in this blog alone; we need our “systems thinking” hats on, with room for critique but also reflection: where exactly are we going with all of this and with what impact other than (creating even more) confusion and complexity for decision makers?

Perhaps, someone like Dr Tedros would be best placed to bring all of this together, given our demands and his role in confronting all of it, eh? From what I heard, he (and his fellow leaders from global organisations) are trying to do so, with a Global Action Plan for healthy lives and well-being for all, that aims to go “beyond the silos”.  We should all get on board!

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