My experience in global health
Authors: Girija Sankar
Journal: The Lancet Global Health (2021)

As someone who has worked mostly with global health professionals from high-income countries over the past 15 years, I ask myself the question if what is wrong in global health is what is right about the noble intentions of progressive individuals and organisations. I have observed that when global health projects work well, they do so because of a high degree of cooperation and collaboration between entities that support the work—for example, between non-governmental organisations in a consortium or partnership, between individuals within these organisations, and between non-governmental organisations and donor organisations who are broadly aligned on goals, vision, and mission. How does this collaboration happen? It is quite simple—people like each other's company. People genuinely like each other's company. But what is at the core of this? The answer is a sense of familiarity and trust. When is trust engendered? Arguably when people of similar backgrounds, political viewpoints, or training work together. Much has been written about epistemic or knowledge communities advancing global health efforts, yet are such communities not formed through chance encounters at scientific conferences, email exchanges, a few coffees, and occasional drinks at the conference hotel bar? Through working in global health at the intersection of practice, policy, and research, I have found myself occupying an insider–outsider role. An insider role in that I am a global health practitioner, but an outsider in that I often feel that I am not privy to conversations that occur outside the formal settings of staff meetings, conferences, or group emails. Ultimately, we work best with those with whom we can foster connections that go beyond the profession. It is the snippets of conversations, the transacting of so-called insider information after the conference ends, during hikes, over a drink, that conversational topics on global health often seem to happen. As a non-native South Asian person in a high-income country working in global health, I rarely run into people like me. What do I need to contribute to share a drink and to plot out disease progression and elimination in Port au Prince, Haiti? And is this very hankering to belong, to be part of an epistemic so-called inner circle not an indicator of what is wrong in global health? If someone in my position feels like an outsider, one can only imagine how much harder it must be for civil society actors (eg, community-based organisations) in low-income countries to establish and feel a sense of connection with the wider global health community. A critical studies definition of global health would consider global health as the practice of public health in high-income countries for low-income countries. It is the work of friends and colleagues at donor institutions trusting their qualified and experienced, no doubt, friends, and colleagues at partner institutions to support the disbursement of millions of aid monies. Trust and familiarity are essential to meaningful and impactful work. That is a truism that nobody would dispute. What is wrong in global health can only be fixed by the same practitioners of global health in high-income countries through deliberate and intentional self-introspection and commitment to behaviour change. The path to greater global health equity winds through the executive board rooms, meeting spaces, hiking trails, and wine bars in high-income countries. If it is a sense of kinship and camaraderie that produces collaborative research, research publications, and evidence-based intervention, I invite global health practitioners in high-income countries to be expansive and generous with their kinship. What are some simple steps we can adopt? Let us be intentional about reaching out to civil society counterparts in low-income countries to participate in epistemic communities ranging from member associations to technical working groups. A call for participation widely shared through multiple media channels is essential, but a basic minimum. Let us pledge to go beyond that and seek meaningful relationships through collaborative work in shared platforms, meeting presentations, joint conference presentations, writing and publishing, and yes, that glass of wine at the conference hotel bar. I declare no competing interests. The opinions expressed in this correspondence are my own and do not reflect the opinion of my employer.