For good “Global Health”, words matter

 

Words inspire us. They shape our culture. They have the power to divide us.

When using alternative words to describe something it is not, we either promote or demote its importance. And thus, we inflate or deflate its actual power or value; sometimes intentionally, other times not.

Fortunately, a group of leading scholars in the field recognised this in a powerful way with their recent piece in BMJ Global Health.

It is time we rethink how we use our words to address the problem of the century, as we hope to “end the pandemic” in 2022. And as the field conducts an introspective examination of our word choices, one theme we must purge is the militarisation of our vocabulary and the resultant unnecessary dramatization of our work.

Perhaps sparked by the Millennium Development Goals and President’s Emergency Plan for AIDS Relief (PEPFAR) in the early 2000s, the world of Global Health has morphed into a contingent of government agencies, development institutions, universities, and nongovernmental organisations (NGOs) responding to calls to combat neglected infectious diseases and eliminate health disparities around the world.

Mobilising the resources to “End AIDS” appears to require an army of all types of well-meaning foot soldiers. To reach lofty goals, campaign generals need to inspire “frontline” health workers to serve in underserved areas and they solicit funding to incentivise research into infectious threats rarely seen in high-income countries. Organisations or institutions led from the United States, United Kingdom, and Europe, speak from headquarters about “boots on the ground” in low-income countries – or rather “in country” – deploying resources “in the field,” simultaneously highlighting the urgency of their work in service to the mission and the power chasm between frontline troop and recipient. The militarised language inspires private donors to rally behind the cause and it inculcates those who want to “go into [the field of] Global Health” with a message: “Work in low-income areas is your duty, potentially dangerous, and, thus, alluring. Fall in formation!”

NGO volunteers drop in, sometimes as part of short-term “missions,” from “Western” countries – or the “global North” – defined as a sort of homogenous block of wealthy states, to “developing countries,” occasionally described as a homogenous block of poor states, despite having needs and context that vary from district to district. “Africa” can be used to describe many things, rarely accurate in its description of a massive and diverse continent with a complicated history.

The language of Global Health also sends a signal to the recipients of the corps’ work. Foreign NGO workers are here to “help,” bringing with them a relatively incredible amount of resources, commonly resulting in unequal and awkward dynamics between donor and recipient. When key decisions need to be made, deferring to the ones with the purse strings tends to be the default. This can then create a patchwork of initiatives created by NGOs accountable to their boards rather than the people they are “serving.”

Now we have an opportunity to replace our diction to meet the current, arguably most pressing, health challenge: vaccinating the world against COVID-19.

“Vaccine equity” is the goal. The “People’s Vaccine” is the solution. Yet, after two years of a once-in-a-century pandemic, 11 novel vaccines, two different US presidents, six million global deaths, and multiple multilateral partnerships, the international community has not been compelled to act in a manner the situation demands. Efforts to divert attention from technology transfers focus instead on the “vaccine hesitant,” some of whom have arrived at their positions thanks to prior health system failures.

We still have a chance to confront COVID-19 with an appropriately massive effort far before the Global Fund or PEPFAR arose to confront the HIV/AIDS epidemic, which was over 20 years after the first cases of HIV were identified. But the sun is setting on our opportunity.

To “end the pandemic,” we must recalibrate our word choices; because our current vocabulary has proven insufficient. Let us demilitarise our lingo and more forcefully speak of collectivism and partnership. Let us garner the political will and harness corporate self-interest by distilling the imperative down to simpler, more accurate, and more appropriately powerful terms.

“We are not safe until we are all safe.” We are all one herd; it is past time to act like it. We should control what we can and hold ourselves accountable. And that starts with the words we use.

About the author: Travis Bias is a Family Medicine physician who has taught medicine in Kenya and Uganda for over one year. He has also taught courses in Comparative Global Health Systems and Global Health Diplomacy for George Washington University’s Milken Institute School of Public Health. Travis is currently Chief Medical Officer of Clinician Solutions at 3M.

 

Competing Interests: I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: I am a full-time employee of 3M.

 

Handling Editor: Neha Faruqui

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