{"id":40013,"date":"2024-11-08T13:08:56","date_gmt":"2024-11-08T13:08:56","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjgh\/?p=40013"},"modified":"2024-11-08T13:10:41","modified_gmt":"2024-11-08T13:10:41","slug":"addressing-the-silent-epidemic-collective-memory-and-the-path-to-global-health-equity","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjgh\/2024\/11\/08\/addressing-the-silent-epidemic-collective-memory-and-the-path-to-global-health-equity\/","title":{"rendered":"Addressing the Silent Epidemic: Collective Memory and the Path to Global Health Equity"},"content":{"rendered":"

 <\/p>\n

Our collective memory: how we remember \u2013 or choose to forget \u2013 the history of global health is playing a silent yet powerful role in shaping which issues receive attention and funding. This distorted memory acts as a long-standing epidemic that undermines the effectiveness of today\u2019s health systems. According to a\u00a0 2024 UN report<\/a>, the Sustainable Development Goals (SDGs) are “severely off track,” with only 17% of targets expected to be met by 2030. This failure isn\u2019t just about missed metrics\u2014it reflects a deeper problem: the global health system\u2019s inability to align around a shared understanding of equity.<\/p>\n

Despite ongoing calls for collective action through global frameworks like the SDGs<\/a>, our efforts remain disjointed. How can we truly align without a shared, truthful understanding of global health history? Current policies are built on historical foundations, but if these foundations are incomplete or inaccurate, the solutions we design will be inadequate to address the real root causes of today\u2019s challenges. While global frameworks have made strides toward addressing social determinants and systemic inequalities, they often fail to confront the uncomfortable truths of colonial exploitation and historical wrongs. This avoidance perpetuates fragmentation within global health, where conflicting narratives continue to drive action without addressing the underlying systemic injustices.<\/p>\n

Why Collective Memory Matters\u00a0<\/strong><\/p>\n

Memory shapes how we act in the present and what we build for the future (Brown et al., 2012)<\/a>. When health inequities are framed as technical problems, global health frameworks miss the opportunity to address their structural roots. Without a shared collective memory \u2014 one that acknowledges exploitation and systemic injustice \u2014 efforts remain scattered. As Walter Mignolo explains<\/a>, decoloniality requires dismantling the colonial matrix of power and making space for new narratives. A collective memory aligned around shared values and historical understanding offers a framework for unifying efforts.<\/p>\n

Toward a Shared Future Collective Memory<\/strong><\/p>\n

In ten years, what story our global health community tell? How will we remember the work we do today? Only by understanding the full scope of our shared history can we inform a meaningful shift. This requires confronting uncomfortable truths including the colonial roots of global health and their ongoing influence on current programs and policies. So, in addition to recommendations set forth by Mishal Khan, Seye Abimbola , Tammam Aloudat, Emanuele Capobianco, Sarah Hawkes, and Afifah Rahman-Shepherd in how to \u201cshift from rhetoric to reform<\/a>\u201d, I provide four key considerations that would help us confront the past honestly and thoughtfully to avoid repeating harmful patterns:<\/p>\n

    \n
  1. Centering Dignity as a Foundational Organizing Principle: <\/strong>Dignity must be a guiding principle at every level of global health. This means embedding respect, agency, and equity into every decision and framework. Dignity-driven systems safeguard the rights and needs of those they serve. By operationalizing dignity, we move beyond paternalistic approaches and shift from charity-based models to equitable frameworks fostering trust, shared power, and mutual respect across all global health efforts.<\/li>\n
  2. Equity Metrics: <\/strong>Global health systems traditionally measure success through donor-defined metrics, focusing on disease control and outcomes. However, equity demands a redefinition of success that emphasizes systemic change, justice, and community empowerment. As Mishal Khan, et al. suggest<\/a>, global health governance must adopt inclusive and participatory structures that allow power to flow equitably across regions. Global health professionals must act as stewards of this process to shepherd a new collective memory.<\/li>\n
  3. Language Matters: <\/strong>Global health terminology has evolved over time to reflect changing political and social perspectives and priorities (e.g., transitioning from “Third World” to “developing” or “low- and middle-income countries”). While these updates seem progressive, they often mask the underlying power dynamics and disparities. Simply changing the language does not fundamentally address these deeper issues. To achieve true equity, we must go beyond surface-level revisions and redefine the terms to promote genuine collaboration, partnership, dignity, and justice\u2014paving the way for systemic transformation rather than cosmetic change.<\/li>\n
  4. Elevating Research Voices from LMICs: <\/strong>Researchers from LMICs often face significant challenges, including limited funding and restricted access to high-impact platforms, which, without meaningful partnerships or support from established institutions, hinder their ability to influence the global health agenda. Catherine Kyobutungi advocates<\/a> for stronger regional leadership to shape research and global priorities reflect local needs. Similarly, Madhukar Pai emphasizes<\/a> that dismantling these barriers is essential for building a truly inclusive and collaborative global health ecosystem.<\/li>\n<\/ol>\n

    The 2030 Agenda<\/a> offers the global health community six years to realign efforts and course correct. Rather than setting new targets, we need to plan for a future <\/em>collective memory that acknowledges historical injustices, reflects shared values, and centers local leadership. But achieving meaningful progress demands a shift from fragmented strategies to shared purpose. The opportunity to realign is here. The time to act is now.<\/p>\n

    About the Author:<\/strong> Yeabsira T. Mehari is a global health professional with over 15 years of experience working in Africa, India, and the USA. She co-leads the Decolonizing Global Health (DGH) initiative at the London School of Hygiene & Tropical Medicine (LSHTM) and is currently completing her PhD in Global Health Equity at Meharry Medical College.<\/p>\n

    Competing Interest:<\/strong> None<\/p>\n

    Handling Editor:<\/strong> Neha Faruqui<\/p>\n","protected":false},"excerpt":{"rendered":"

      Our collective memory: how we remember \u2013 or choose to forget \u2013 the history of global health is playing a silent yet powerful role in shaping which issues receive attention and funding. This distorted memory acts as a long-standing epidemic that undermines the effectiveness of today\u2019s health systems. According to a\u00a0 2024 UN report, […]<\/p>\n

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