IHP News 585 : There Will Be Hope

IHP news 585 : There will be hope ( 21 August 2020) The weekly International Health Policies (IHP) newsletter is an initiative of the Health Policy unit at the Institute of Tropical Medicine in Antwerp, Belgium. Dear Colleagues, Last weekend I heard “Jerusalema” for the first time (in a Belgian news bulletin on tv, actually), a catchy song that has already sparked plenty of synchronous dancing around the world and lifted numerous moods, I reckon. Arguably, I’m late to the party, not being South-African nor on TikTok (and more to the point, about as hip as you would expect from a (nearly bald) 47-year old). So far, an ITM version of the dance also didn’t materialize yet, as far as I know, but when it happens, it will be a major “global health event” to cover, for sure ! In any case, the song gives one hope, so it’s perhaps no coincidence that it has not just become a worldwide summer hit now, but also the unofficial anthem of the Covid-19 response, a #safelysocializing one moreover. As long as there is music, there will be hope for this world. Indeed, whether on Covid-19, the climate and biodiversity emergencies, the grotesque inequity “characterizing” our economic system, or "November", deep down, we have to believe that, like in Hollywood movies, the good will eventually prevail over the bad, or light over darkness. Even if human beings are not particularly good at long term thinking, let alone 7 generations ahead, as argued for in a recent blog by Stuart Gillespie on intergenerational equity. Starting from Roman Krznaric’ latest book, The Good Ancestor: how to think long term in a short-term world, Gillespie referred in his article to the Iroquois concept of ‘seven generation stewardship’, picked up recently also by the Lancet Syndemic Commission report. The concept “urges the current generation to live and work for the benefit of the seventh generation into the future.” As you can tell on a daily basis, neoliberal capitalism is a stunningly effective system to do just that. Cynical remarks aside, however, given the blatant lack of ‘seven generation stewardship’ by most of our current leaders and CEOs, criticism of the younger generation (dubbed by some “generation Covid”), certainly of the dichotomous kind (as in “Young people ‘saints or sinners’ ?” ) feels more than a bit unfair. Can we agree that all of us, not just the young, can be both saints and sinners, depending on the situation or occasion? That’s what it means to be ‘human’, after all. Moreover, that their generation is expected to clean up the planetary (ill-health) mess of the past 7 generations? A bit exaggerated, perhaps, but you get the point. You’d “party till you drop” for less if you were 18 now. And let’s not forget, as a spot-on Guardian op-ed put it this week, “neoliberalism is spreading coronavirus faster than any “reckless teenager” ever could”. Exactly. When we try to build better in the years to come, seven generation stewardship is what we need. If and when that happens, mankind will at last have more hope. Rich and poor. As well as the generations to come. Enjoy your reading. Kristof Decoster 1 Featured Article Decolonial thought and African consciousness for socially just health systems: An imaginative space Lance Louskieter (PhD Candidate, Health Systems and Policy Research Division, School of Public Health and Family Medicine, University of Cape Town, Queer Activist, Decolonial Scholar, Advocate for the decriminalization of sex work in South Africa. Senior Atlantic Fellow for Health Equity at Tekano) and Shehnaz Munshi (HPSR researcher, occupational therapist, Emerging Voice (2018) and Senior Atlantic Fellow for Health Equity at Tekano. Currently she is the Project Manager for the Sheiham Family/Wits program on social determinants of health and health equity, School of Public Health, University of the Witwatersrand. She serves on the steering committee of the People's Health Movement. ) On the 1st and 2nd of October 2020, we plan to host a virtual Africa convening to have a conversation about decoloniality in the broader field of Global Health. The purpose of the convening is for African health scholars and practitioners to build collective capacity to engage in critical decolonial thinking in order to re-imagine socially just African health systems. While the importance of decolonial perspectives for global health has emerged in recent years, many of the discussions and ideas have, so far, been concentrated in well-resourced global north institutions which is once again in line with the colonial project. Decolonizing health in Africa must therefore, necessarily, include African scholars shifting their focus inward to build solidarity across the continent. They must break down the silos and divides that exist across the diverse African contexts, and re-imagine African knowledge and realities as valuable, and the people as legitimate knowledge bearers. The convening, in early October, which is supported by the HSG Africa regional network, the Atlantic Institute and Tekano, will allow African health scholars to engage authentically and honestly, and make space for difficult conversations about power and hegemonic epistemologies. These conversations are part of a larger initiative, and will therefore make links with the HSR 2020 symposium organized session (track 5), scheduled for Thursday, Nov 12, 2020, titled “What does a socially just health system look like: an imaginative space?”. Stay tuned for that. In the convening, we intend to build a bridge between the global health and decoloniality communities which, while related, often operate separately. The goal of the convening is for health thinkers and practitioners to learn from decolonial thinkers and practitioners. During the event, we will consider the limitations of (globally) hegemonic epistemologies, and their implications for African health and health systems. Explicit decolonial thinking can facilitate a process of African conscientization - that is, an unthinking/ unlearning/ unravelling of the ’status quo’ in episteme traditions to help us critically reflect on the way we think about the world and the things we do. Decolonial thought as a segue toward African-centred socially just health systems In a podcast entitled “Covid-19 and its impact on the Geo-politics of knowledge production”, Prof Sabelo Ndlovy Gatsheni discussed how decolonial thinking enables the politicizing and historicizing of health and health systems challenges in Africa, and enables us to call out the insidious and ubiquitous ways in which coloniality manifests itself in health systems and policies and in African health. This is work of disruptions, shifts and explicit engagement with oppressive power to improve 2 the lives and re-instil the dignity of African people and places. What are we shifting away from? What the colonial project has predetermined: that African people cannot produce knowledge and that they are not legitimate holders of knowledge. We radically resist narratives of Africa as a ‘dark’ continent and discourses about its people being primitive, and the nuanced and insidious ways in which these ideas persist both in contemporary global relationships and within African institutions of academia, civil society and health systems. Instead, decolonial thinking requires health thinkers and practitioners to explicitly name invisible power that continues to reinforce and perpetuate oppression, marginality and poor material and social conditions of African people. Moreover, the decolonial project calls for African health scholars and practitioners, despite good intentions, to critically reflect and be reflexive on how our training, research and practices perpetuate the very systems of oppression underlying the field of global health and (post-)colonial medicine. We need to move away from stereotypes that exist within ourselves about ourselves, and de-centre “weaknesses” constructed by and through colonialism. A shift away from the white and ‘foreign’ gaze, is an important step. We also need to look to critical social science theories, ideas and strategies that challenge predominant racial, patriarchal, sexist, homo- and trans-phobic conservative, liberal, and neoliberal politics in African settings. Explicitly connecting decolonial thought to a discourse of health in Africa can inform a paradigm shift in health which ignites African consciousness amongst health practitioners and fosters the development of Afrocentric and socially just health systems and policies. An alternative decolonial Pan-African paradigm that can advance socially just health systems and policies (and the role of HPSR in this) As Molefi Asante put it, African intellectuality has been undermined for far too long. Against this overall backdrop, the convening will hone in on Health Policy and Systems Research (HPSR) as a progressive field on the continent and its success and possibilities for African-centredness in its knowledge and praxis. The field of HPSR offers us theorisations and empirical work to guide us in engaging with the social, economic and political nature of health systems. Over the past decade, HPSR scholars in Africa have utilised different knowledge and methodological approaches across disciplinary boundaries, with a particular focus on foregrounding the legitimacy of often under- valued social science contributions. HPSR scholars have also increasingly theorised and worked with local actors, including policymakers and civil society who have shaped the nature of HPSR. In this convening we will explore how the field can go further. Decolonial thought leaders and health thinkers and practitioners will reflect on the possibilities for alternative paradigms of knowledge and for the curating of an African/decolonial archive of health knowledge and praxis to advance socially just health systems on the continent. We seek to engage with the existing knowledge archive in African health and health systems and policy work and reflect on the knowledge contributions from different parts of the world, what Gatsheni calls the “ecology of knowledge”, examining dominant knowledge paradigms and how knowledge is used to assert power and authority.

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