Gautier Lara, Sieleunou Isidore, Kalolo Albino
School of Public Health, University of Montreal, Montreal, Canada.
University of Montreal Public Health Research Institute, Montreal, Canada.
BMC Med Ethics. 2018 Jun 15;19(Suppl 1):49. doi: 10.1186/s12910-018-0280-7.
Global health conceives the notion of partnership between North and South as central to the foundations of this academic field. Indeed, global health aspires to an equal positioning of Northern and Southern actors. While the notion of partnership may be used to position the field of global health morally, this politicization may mask persisting inequalities in global health. In this paper, we reflect on global health partnerships by revisiting the origins of global health and deconstructing the notion of partnership. We also review promising initiatives that may help to rebalance the relationship.
Historical accounts are helpful in unpacking the genesis of collaborative research between Northerners and Southerners - particularly those coming from the African continent. In the 1980s, the creation of a scientific hub of working relationships based on material differences created a context that was bound to create tensions between the alleged "partners". Today, partnerships provide assistance to underfunded African research institutions, but this assistance is often tied with hypotheses about program priorities that Northern funders require from their Southern collaborators. African researchers are often unable to lead or contribute substantially to publications for lack of scientific writing skills, for instance. Conversely, academics from African countries report frustrations at not being consulted when the main conceptual issues of a research project are discussed. However, in the name of political correctness, these frustrations are not spoken aloud. Fortunately, initiatives that shift paternalistic programs to formally incorporate a mutually beneficial design at their inception with equal input from all stakeholders are becoming increasingly prominent, especially initiatives involving young researchers.
Several concrete steps can be undertaken to rethink partnerships. This goes hand in hand with reconceptualizing global health as an academic discipline, mainly through being explicit about past and present inequalities between Northern and Southern universities that this discipline has thus far eluded. Authentic and transformative partnerships are vital to overcome the one-sided nature of many partnerships that can provide a breeding-ground for inequality.
全球健康将南北伙伴关系的概念视为这一学术领域基础的核心。事实上,全球健康追求南北行为体的平等定位。虽然伙伴关系的概念可用于从道德层面定位全球健康领域,但这种政治化可能掩盖全球健康中持续存在的不平等。在本文中,我们通过回顾全球健康的起源并解构伙伴关系的概念来反思全球健康伙伴关系。我们还审视了可能有助于重新平衡这种关系的有前景的倡议。
历史记录有助于剖析南北双方——尤其是来自非洲大陆的人们之间合作研究的起源。在20世纪80年代,基于物质差异建立的科学工作关系中心营造了一种必然会在所谓“伙伴”之间引发紧张关系的环境。如今,伙伴关系为资金不足的非洲研究机构提供援助,但这种援助往往与北方资助者要求南方合作者遵循的项目优先假设挂钩。例如,非洲研究人员常常因缺乏科学写作技能而无法主导或实质性参与出版物的撰写。相反,非洲国家的学者表示,在讨论研究项目的主要概念问题时未被征求意见让他们感到沮丧。然而,出于政治正确性的考虑,这些沮丧并未被大声说出来。幸运的是,将家长式项目转变为在项目启动时就正式纳入互利设计且所有利益相关者平等参与的倡议日益突出,尤其是涉及青年研究人员的倡议。
可以采取若干具体步骤来重新思考伙伴关系。这与将全球健康重新概念化为一门学科密切相关,主要是要明确该学科迄今一直回避的南北大学过去和现在的不平等。真实且具有变革性的伙伴关系对于克服许多可能滋生不平等的单边伙伴关系至关重要。