Power Dynamics in Global Health Research
About halfway through my Global Health Corps fellowship, I was sitting in a conference room for a week-long workshop on research ethics in Zambia. As we were talking about HIV research, someone suggested that there must be a cure for HIV but the Westerners were hiding it and using the entire continent as an experiment. I was initially shocked and bewildered by this statement. I thought “How could someone think that?” To my surprise, two more people joined in and expressed their agreement. The discussion started getting heated and I looked to the chairperson for guidance. He was standing at the head of the room and responded diplomatically to quell the discussion.
This encounter made me think a lot about the impact of colonialism on global health to this day. Colonization of modern-day Zambia began in the late 19th century and the British government ruled until 1964. During this time, colonizers committed numerous human rights violations and abuses of power for the sake of extracting resources to benefit the colonizing nation. They took land and resources, such as copper, away from the Zambian people. They forced some Zambians to work as slaves and to fight in their wars. The colonial subjugation of the African people occurred in many other African countries, creating resentment and distrust of the Western world in many places.
In the early 20th century, colonial governments would often conduct health campaigns aimed at controlling tropical diseases in Africa. For example, over the course of several decades, the French colonial government in Cameroon and former French Equatorial Africa conducted a campaign to prevent sleeping sickness, a deadly disease spread by the tsetse fly. They subjected millions of individuals to medical examinations and forced injections of medicines with uncertain efficacy and serious side effects, including blindness, gangrene, and even death. For many, this was their first exposure to modern medicine.
During the colonial period, there were no universal ethical standards for “human subjects” in research. African populations were often exploited and used against their will for experimentation. Thankfully, over time, health research was regulated. In 1947, the Nuremburg code was created to protect human research participants from the cruelty and exploitation that the prisoners had endured at the Nazi concentration camps. In 1964, the Declaration of Helsinki was written and went into more detail on human research participants’ protection, rights, and autonomy.
Despite advances in research ethics coinciding with the end of colonialism, the history of exploitation and the power dynamics of modern global health research continues to perpetuate distrust among some Africans. Many research projects in Africa are conducted and financed by researchers from high-income countries (HICs). Collaborating with researchers and institutions from HICs can bring expertise, funding, and resources to African nations for the purpose of research. However, this can also lead to a power imbalance. Institutions funding research have the power to dictate the research agenda. Researchers from HICs have been accused of “extractive research” — flying into a low-or-middle-income country to take samples or data and leaving with the recognition of publication. This one-way relationship is not acceptable.
Many efforts have been made to improve the power dynamics of global health research. Researchers from HICs are collaborating and including local researchers on their study teams, which should be the norm. Many countries (such as Rwanda and Zambia) require local authorship on manuscripts for studies conducted in their countries. There have also been efforts made by HICs to build capacity for health research (particularly for clinical trials) in Africa. For example, the European & Developing Countries Clinical Trials Partnership (EDCTP) promotes research among African institutions through pan-African clinical databases and funding research projects. In Zambia, to combat extractive research and share study results with the study population, it is mandatory that results from health studies be shared locally before being published externally.
However, misconceptions surrounding research still exist. I think one of the best ways to combat them is to focus on locally-driven research and equitable collaborations between HICs and the countries in which they are seeking to conduct research. Researchers from HICs should approach local researchers with some knowledge of the context of the country and allow them to also drive the research. Without genuine collaboration and focus on locally-identified priorities, the power dynamics in global health research will always be uneven and distrust will continue to fester.
Colleen Leonard was a 2018–2019 GHC fellow in Zambia.
Global Health Corps (GHC) is a leadership development organization building the next generation of health equity leaders around the world. All GHC fellows, partners, and supporters are united in a common belief: health is a human right. There is a role for everyone in the movement for health equity. To learn more, visit our website and connect with us on Twitter/Instagram/Facebook.
