Category Archives: Trickle Down Science

The cartographic challenge of decolonising global health

A navigational chart from the Marshall Islands, on display at the Berkeley Art Museum and Pacific Film Archive. It is made of wood, sennit fibre and cowrie shells. From the collection of the Phoebe A. Hearst Museum of Anthropology at the University of California, Berkeley. Date not known. Photo by Jim Heaphy. (Wikipedia; CC BY-SA 3.0)

There are a growing number of papers in the peer-reviewed literature about decolonising global health (see). Pascale Allotey and I have discussed the problem in terms of “trickle-down science” (also see). That is, the way (global health) science is done, how it is prioritised, and who is advantaged. It is a description of science generally conceived and managed from powerful institutions in the global north, with implementing partners in the global south, their factories for data collection. We have also critiqued critiques that advocate a utopic version of global health, arguing that:

decolonising global health extends beyond relations between [low- and middle-income countries] LMICs and [high-income countries] HICs; it is also about the relationships within them. Decolonisation is fundamentally about redressing inequity and power imbalance.

The latest offering on the altar of peer review is a three-step roadmap to the decolonisation of global health and a call to join the authors on their journey. Maps, however, are tricky things. They are culture-bound and themselves tools of colonisation. Their design, content, and what they highlight and ignore require a shared and agreed understanding of the path and the goal. Woe betide the European sailor trying to navigate using the Marshall Islands stick chart.

Much as I applaud the idea of redressing the power imbalance in global health, this particular attempt is tone-deaf. It is presented as if decolonisation was waiting for six authors from three of the world’s wealthiest countries to explain it to “the colonies”. Readers will forgive the irony that the first and last authors of the roadmap are at the London School of Hygiene and Tropical Medicine (LSHTM) — an institution established to support the colonial administration of the world’s greatest empire — an institution that, to this day, encourages and benefits from neocolonial relationships with the global south. The authors note these kinds of relationships and bravely forge on.

In developing the roadmap, the authors draw parallels with the feminist movement. An apt analogy (tongue firmly in cheek) because who cannot recall the importance to the feminist movement of first having men in power explain how it should be done? The men were so quick to relinquish their power that one barely remembers the days of gender inequality. Who does not know (tongue back behind teeth) that women of privilege often powered the first and second waves of feminism? The movement systematically failed to account for class differences, colour lines, and culture — leaving many women behind—the voice matters.

Who has the right to speak for whom in global health is a challenge. In a previous article, I wrote about this very issue. Fighting over the legitimacy of the voice is always fraught, and passions can run high. Are voices from some countries/institutions with this or that history as a colonial master or servant more or less valued than others? Is it more or less hypocritical to privilege voices from LSHTM, Johns Hopkins University, or the University of Washington over those from Makarere University, the Tata Institute of Social Sciences, or the Oswaldo Cruz Institute?

“Decolonising” is ultimately about forgoing power and transferring power. It is something that has to happen between countries and within countries. There is a cacophony of voices, all of which should be heard — but they are not equally important. They do not all warrant the same time and space. The authors of “the roadmap” are neither transferring nor forgoing power. As the cartographers, they determine the path, the points of interest, and the rest stops.

The roadmap for decolonising global health should not be determined nor led by countries and institutions simultaneously holding the whip and the chum.

#decolonising #decolonising #globalhealth.

With any piece I write about decolonising global health, I always have two competing voices in my head: “this issue is important, say it” and “should I be the one saying it?” I will declare my conflicts, and you can decide if you want to listen to or shoot the messenger. I am a white male born in (not by choice) the British Colony of Southern Rhodesia. In virtue of privilege and choice, I have lived and worked in Australia and the UK, and for the last 12 years, Malaysia and Bangladesh. My partner and I moved to Southeast Asia. Then I moved to South Asia because we were committed to capacity building and decided it was no longer appropriate to work in the global health space while sitting in a high-income country. I have never held appointments at LSHTM, Johns Hopkins University, or the University of Washington.

The original article was first published on medium.com on 26 March 2021. This version is very slightly edited.

Indonesia pushes back against trickle down science

A recent article in Science Magazine (July 2019) described changes to Indonesian laws regulating the way that foreign scientists can do science in Indonesia. The laws are, in essence, a push back against “trickle down science“, in which scientist in Global North Institutions engage in colonial science. This is what happens when Global North researchers engage local institutions to provide service scientists and easy access to samples without any genuine consideration for their Global South collaborators.

The implications of the new law are still uncertain, but it may affect one of the studies on which I am in investigator. The change in the law means that

[Foreign scientists] need to get ethical clearance from an Indonesian review board for every study (although some types of studies may be exempted), submit primary data and published papers to the government, involve Indonesian scientists as equal partners, and share any benefits, such as the proceeds from new drugs, resulting from the study. Researchers can’t take samples or even digital information out of the country, except for tests that cannot be done in Indonesian labs, and to do so, they need a so-called material transfer agreement (MTA) using a template provided by the government. (Rochmyaningsih, 2019)

A Bajaut Laut community in Sabah, Malaysia. It was a study in a community like this one in Indonesia that sparked a debate about subaltern science.

It is hard to fault any of the new requirements. Of course there should be ethical clearance and of course the clearance should come from the country in which the science is being done. Lodging the data and the papers seems like a reasonable idea. The Indonesian governments wants papers and data lodged with the them; a bolder and more constructive approach may be for data and papers to be lodged in accessible repositories. Of course Global North researchers should have in-country scientists as partners and of course the collaborators should be equal partners — not pretend equal partners, but actual, equal partners. Of course the benefits of the science should flow to all the countries engaged in the science. These are not high hurdles to jump unless the scientists from the Global North thought they should be able to arrive, collect samples, and run … which would never happen, right?

I could have predicted the kind of response that has already begun with the announcement of the Indonesian law, because I have heard the responses before. Indonesia (or insert the name of your favourite Global South country here) doesn’t have the capacity to do the research that we want to do. It wasn’t the research idea of the scientists in Indonesia, it was our idea. These new laws will destroy science in Indonesia, because any credible Northern researchers will move to a more accommodating country; i.e., a more readily exploitable country. Every single one of these responses condemns the person who utters them, because each one shows a complete lack of commitment to genuine, scientific collaboration.

The issue of #trickledownscience seems to have come to a head in Indonesia with the publication of an article in Cell — the high impact factor (36.2) journal in experimental biology. The article, reported a study of genetic adaptations to hypoxia in the Bajau Laut people, a nomadic, sea-dwelling community in Southeast Asia. The article is fascinating and well worth a read, and the authors should be congratulated on a great piece of science! The problem is not with the findings, it is with the process of Northern Scientists going to far flung places to do their research without any genuine engagement or collaboration with local scientists. There are 17 authors listed on the paper and with only one exception they come from Denmark, Germany, the Netherlands, the UK and the US. The exception is author #15, an Indonesian who is and education researcher and has no background in genetics or cell biology, and whose contribution was to “provide logistical support”. Author #15 comes from Tompotika Luwuk Banggai University — a small, private institution in Central Sulawesi; underscoring the lack of genuine collaborative intent, Tompotika’s university ranking is 498 in Indonesia and 12,999 in the World. This is a far-cry from, to give one example, the more relevant and credible Eijkman Institute for Molecular Biology in Jakarta.

The publication of the article received good coverage in The New York Times, and less desirable coverage in Science Magazine. The heart of the problem is revealed in a comment by Melissa Ilardo, who was the doctoral student on the study and the first author of the Cell paper. Commenting on the controversy, she said, “I did everything I could to conduct this research ethically and properly, and this is breaking my heart”. I truly feel for her. To be a young (post-)doctoral student and have to go through this kind of scrutiny would be awful. But just think about Ilardo’s idea of “doing everything” to conduct the research properly. What does it mean to conduct oneself properly when the #trickledownscience relationship is a profoundly colonial one. The study looks a lot like the modern day equivalent of the Elgin Marbles; however, instead of retrieving (stealing?) ancient artefacts, Global North reseaerchers  collect biological samples.

The new Indonesian law is probably too heavy handed, but it is in the right direction. There is little doubt that there is a problem with #trickledownscience, and governments in the Global North, funders, and institutions need to push the nascent dialogue with the Global South about how appropriate, collaborative science can develop that addresses the needs of the Global South and not the whimsies of scientists in the Global North.

I predict it will be those Global North institutions that tackle this issue head-on that will be the most successful. It does require that they give up a little power to retain a little power, and it begins by negotiating genuinely, collaborative arrangements that address (1) the most pressing scientific questions in the Global South, (2) the building of capacity in the Global South, (3) sustainable funding for research in the Global South, and (4) sustainable, collaborative research relationships between the Global North and the Global South.

I was trying to imagine what the response in the US would be if a group of Indonesian, Nepali, and Tanzanian scientists arrived in the US to collect saliva samples from a Hasidic community in upstate New York or an Amish community in Pennsylvania. A young academic at a local community college would provide “logistical support” and facilitate obtaining ethical clearance from the college’s Institutional Review Board. The samples would be collected from the community and shipped back to the Eijkman Institute in Jakarta for analysis. A paper would subsequently appear in Nature detailing some interesting genetic variations associated with the communities. Would the science be celebrated in the The New York Times or would someone have a WTF moment and question how this could ever happen?

I am looking forward to that studying being done. Will NIH fund it, I wonder?