As 2020 draws to a close, our chair Dr Aula Abbara reflects on what has been among the most challenging, interesting and humbling years in global health for most within the Health Professionals for Global Health community.
Reflections on a year in global health
At HPforGH, our motto has always been that global health as a concept is key to any health professional’s life in the UK; it is not something that happens outside of the UK’s borders but something in which we must be conversant daily. This is affirmed by the COVID-19 pandemic which has brought increased interest to many issues which are fundamental to global health practice to our doorstep; these include health system preparedness and responses, inequalities, politicization of health, social determinants of health, governance, ethical challenges and the development and roll out of treatments and vaccines. Though COVID-19 has garnered the most attention, other global health challenges have not gone away and many have been adversely affected by the often unilateral focus on the pandemic, particularly from funders. Other global health issues continue including forced migration, conflict, climate change and stark inequalities in health both within our societies and across borders.
This figure shows the Global Health core competencies which were formed after a consultation with key stakeholders; see here for more information. Figure from Walpole et al. (may show at the end if using a mobile)
These inequalities are seen within our UK health system and response to the COVID-19 pandemic. In the UK, our government’s response has been heavily criticised, placing increased strains on an already overstretched NHS and workforce. Richard Horton, editor of the Lancet, vocally highlighted such concerns as early as March 2020 with the now borne-out fear that patients and health workers will lose their lives unnecessarily. Those from ethnic minorities in the UK have been particularly affected with higher rates, severity and poorer outcomes from COVID-19. This includes healthcare workers. The UK has had among the highest number of health workers die from COVID-19; of these more than 60% are from ethnic minority backgrounds. We also see the additive effects of the hostile environment where access to essential health services are adversely affected by policies which increasingly restrict access or financially penalise those who have immigrated to the UK despite this workforce being essential to the NHS and our wider society.
A key theme of 2020 has been around important discussions on ‘decolonizing global health’ and ‘decolonizing global health education’ which are gaining increasing traction with various initiatives addressing the roots of institutional inequality in global health; this will hopefully encourage a new generation to think critically of concepts within global health. This is something that we feel passionately about at HPforGH. At the Imperial College Global Health BSc at which I teach, positive strides have been made to turn the curriculum on its head and provide opportunities for public health specialists from the context under discussion (in our case, the Syrian conflict) to set the agenda, with the hope that this provides more authentic educational experiences to students who will be future global health practitioners. This not only equips with the required skills and knowledge but also the required attitudes and awareness of power dynamics in global health and privilege. Such movements have come through academic and humanitarian institutions where institutional racism is also increasingly (and rightly) challenged.
Through the lens of COVID-19, we can understand the fractures within health systems and societies, the politics of responses and what the SDG (Sustainable Development Goal) of ‘Leaving no one behind’ means for the millions who have inadequate access to basic health services. This includes the forcibly displaced, particularly those who are internally displaced who are among the most vulnerable. (See this excellent selection of briefs from different contexts from the Lancet Commission on Migration to which HPforGH committee members contributed and this piece from Jess Hanlon about her reflections on COVID-19 among refugees in Greece.) A key element of this will be how the COVID-19 vaccines are distributed so that they can reach and protected the most marginalised in our societies. Conflict, economic insecurity, climate change and other factors continue to force people from their homes and yet even in high income countries, we have yet to treat those fleeing such unimaginable hardship with the dignity they deserve.
Arundhati Roy describes in the FT article ‘The pandemic is a portal’ that “Historically, pandemics have forced humans to break with the past and imagine their world anew. This one is no different. It is a portal, a gateway between one world and the next.” The disruption of COVID-19 presents an opportunity for change. Green New Deal UK launched the Build Back Better campaign in May, and health professionals, including HPforGH, were quick to join the call to re-imagine how society could comprehensively respond to this syndemic: an ambitious program of investment in green jobs and infrastructure to tackle the multiple crises we face at the intersection of health, social inequality and climate change. We have also been proud to be part of the “Hands Up For Our Health” coalition, fighting for everyone in the UK to have the chance to access healthcare, during COVID-19 and beyond.
Reflecting on 2020 and planning for 2021
This year, the HPforGH committee has focused on advocacy and exploring issues pertinent to global health for the UK and wider health professional. These have included webinars, blogs, research and media work which highlight issues including global health security, AMR, COVID-19, climate change, forced migration, opportunities in global health, opportunities in wilderness medicine and the value of global health experiences to our NHS work.
We have updated our resources page to encourage engagement with various organisations, NHS England’s global health portfolio among other useful resources. Though we have a UK focus, we are grateful for the reach we have internationally with a network that spans all continents and hope to build on this. As part of this, our communications officer Jess Hanlon has brought together COVID-19: Global Healthcare Voices a poignant and sometimes heart-breaking exploration of experiences across the globe.
Through 2020, the HPforGH committee will continue our focus on advocating for global health competencies to be integrated into the curricula which train our health workers; we will increase our advocacy around refugee health workers alongside the WHO’s designation of 2021 as the year of the health worker; continue highlighting and advocating for the needs of forced migrants in Europe and outside; increase our collaborations with organisations with which we share common goals because, if we have learned nothing from the COVID-19 pandemic, we are stronger together.
Stay in touch
As 2020 draws to a close, we would like to thank those who have contributed to our work or who have partnered with us: @RSHTM, @ISID, @SFGH Imperial, @PanSurg, Adam Gray, Saleyha Ahsan, David Heyman, Safia Akhtar, Gavin Stead, Afsana Safa, Kate Jarman, Scott Pallett, Daniel Grace and our committee: Liz Hardman, Jess Hanlon, Sarah Denny, Rita Issa, Natalie Webber, Aula Abbara. Visit our website on hpforgh.org.uk where we have uploaded professional resources, the NHS Global Health portfolio and recordings of our events and subscribe to our facebook page, twitter account (@HPforGH) and quarterly newsletter.