A few years ago, I was having dinner during the UN General Assembly with an inspiring global health colleague who is not afraid to speak his mind, and has a lot of experience and great lessons to share. I was feeling quite constrained in my job intellectually, and realized I was craving for some new thinking and thought leadership in global health. I asked my colleague to share suggestions of who is thinking outside of the box in our sector, who is not afraid to speak out, and who is truly interested in moving the needle on impact.
I have been following the work of these people and many more since, and the freedom of thought, research, and discussion I saw has been one of my inspirations to start writing (and thinking) again. I started asking myself what I really think and know about the issues I am working on, what my principles are, and where I personally think I can add value on – and have the space and support to do so.
I have throughout my career focused on diversity and inclusion in global health. Most of my positions have aimed to include the voices of unheard but affected populations into the global health discussion: children, adolescents, women, stigmatized people, and people who are discriminated against or ignored because they lack the financial means, citizenship or job to have their voices heard.
But I have also felt uncomfortable at times in how organizations or organizers of events (willingly or subconsciously) select representatives from these populations, or in the worst case dictate what they should say or how they should behave. In practice, this means that many such representatives have not been able to speak on behalf of the group they are there to represent, and their participation has been more tokenistic than real.
I have also at times represented such populations. I have been invited to speak because I am a woman, a working mother, or when I worked in civil society. I was supposed to represent people who are discriminated against and left out. I have tried to do so, by using a platform to highlight their challenges and issues. But have I been the right representative to speak on their behalf – with all of my own privileges, such as education, citizenship, geographic location, financial means, and my race? Or have I just been the token woman, CSO representative, etc? I admit I have often felt uncomfortable because of these questions I have asked myself.
I have seen these same challenges in my work throughout the years, for example in how many organizations deal with CSOs. It’s tick-the-box tokenism, and in the worst case instrumentalization. Both sides (the organization and representatives) bear some responsibility on how these relationships are used and abused, and it’s important also to call out that many representatives of underrepresented groups (women, CSOs, etc) greatly benefit from the access, visibility and perks they are given through their representation. The relationship easily becomes unhealthily symbiotic.
Because of these discomforts, I together with Ngozi Erondu and Madhu Pai (two great thought leaders in global health who are unafraid to speak their minds also on difficult issues) co-wrote an article in Think Global Health, Silenced Voices in Global Health.
We pose questions and discuss issues such as: What does real diversity mean and look like, and what will it take to get to real inclusion in global health? How can transparency help? And why do we need more critical self-reflection?
I am aware this is a difficult discussion to have. Many people really are underrepresented and discriminated again, stigmatization and discrimination are very, very real – as we can see even more poignantly again these days thanks to Covid19, and what is happening in the United States.
But we also need to make sure we are truly supporting those people who are discriminated against, not just pushing ourselves into the limelight because we share some attribute with other people. And we need to be transparent about who we really are, and what we can – or cannot – represent.
Katri Bertram 