Montenegro Cristian, Abarca-Brown Gabriel, Flores Elaine C, Susser Ezra, Rivera Eliut, Paniagua-Ávila Alejandra, Florence Ana Carolina, Mascayano Franco
Department of Global Health and Social Medicine, King's College London, London, UK
Programa de Salud Mental Global, Universidad Andres Bello, Santiago, Chile.
BMJ Glob Health. 2024 Dec 11;9(12):e015923. doi: 10.1136/bmjgh-2024-015923.
The decolonise global health movement has critically reassessed the field's historical and political underpinnings, urging researchers to recognise biases and power imbalances through reflexivity and action. Genuine change is seen as the outcome of the researcher's self-awareness, often leaving the underlying structures of global health-and global mental health (GMH)-in the background. Here, we problematise how expectations around agency and change have been mobilised in discussions around decolonisation, highlighting the gradual and contingent nature of international collaboration in GMH.We present three international research initiatives based in or focused on South America: RedeAmericas, the Platform for Social Research on Mental Health in Latin America and the HEalthcaRe wOrkErS project. Instead of comparing the three initiatives directly we identify and discuss common elements among them that challenge and redefine the boundaries of GMH by leveraging local leadership, creating hybrid expert profiles and implementing principles of equity and epistemic justice. Particular attention is given to the fragmentary translation of these principles into the project's concrete activities.The interplay of agency and the structural confines of GMH is examined in each initiative, expanding the notion of 'boundaries' in the field beyond geographical or institutional demarcations. Using the notion of milieu, we call for a more nuanced understanding of the field as simultaneously shaping and being shaped by the tentative collaborative infrastructures developed by researchers. We advocate for a reconceptualisation of GMH that is as diverse and complex as the issues it seeks to address.
去殖民化全球健康运动对该领域的历史和政治基础进行了批判性的重新评估,敦促研究人员通过反思和行动来认识到偏见和权力不平衡。真正的变革被视为研究人员自我意识的结果,而全球健康——以及全球心理健康(GMH)——的底层结构往往被置于背景之中。在此,我们对围绕去殖民化的讨论中如何调动对能动性和变革的期望提出质疑,强调全球心理健康领域国际合作的渐进性和偶然性。我们介绍了三个以南美洲为基地或聚焦于南美洲的国际研究倡议:美洲网络、拉丁美洲心理健康社会研究平台以及医护人员项目。我们并非直接比较这三个倡议,而是识别并讨论它们之间的共同要素,这些要素通过利用地方领导力、塑造混合专家形象以及实施公平和认知正义原则,对全球心理健康的边界提出挑战并重新进行定义。我们特别关注这些原则在项目具体活动中的零碎转化。在每个倡议中,我们都考察了能动性与全球心理健康的结构限制之间的相互作用,将该领域“边界”的概念扩展到地理或机构划分之外。借助环境的概念,我们呼吁对该领域有更细致入微的理解,即该领域既塑造着研究人员所构建的试探性合作基础设施,同时也受到这些基础设施的塑造。我们主张对全球心理健康进行重新概念化,使其与它试图解决的问题一样多样化和复杂。