Issues in Interdisciplinarity 2018-19/Imperialism in Global Health

Global health – a “collaborative trans-national research and action for promoting health for all” – is an inherently interdisciplinary issue, despite stemming primarily from medicine. Varying definitions imposed by disciplines involved like economics, politics and anthropology create conflict in the process of finding a solution and reaching a desired outcome. Clearly, economics and politics would dictate the organisation of funding to the most damaging health issues but the question remains whether quantitative or qualitative data is more useful in analysing these issues and concluding what is the most damaging. Anthropological studies are necessary when culture actively undermines scientific insight into medical problems through religious ideology or traditions, preventing accurate data collection. Indeed, mental health is just one example of a complex issue in which treatment and perception of differ significantly according to culture. Imperialism, particularly Eurocentrism, therefore affects the research underlying global health, particularly in terms of how data is collected and presented and leads to Western definitions of health being imposed onto the rest of the world.

Imperialism, having a pervading influence over several aspects of modern culture, can be defined in several ways. Kushar notes the underlying “principle of universality” which is inherent in empires, suggesting that the role of an empire is to impose a singular concept of civilisation and thus defining imperialism as designating “a rule over a large space and many peoples”. This, however, seems to limit the definition of imperialism as applying to a physical empire. Whilst Galtung supports this to some extent, arguing that imperialism exists “particularly between the nations,” the view is also taken that imperialism can be seen more broadly as leading to two main issues: inequality and resistance to change. Nuzzo, furthermore, argues that the “de-westernization, decolonization and re-westernization” calls for how imperialist legacies are viewed in modern-day to be rethought: this broader perspective can be used to view how imperialism, particularly Eurocentrism – the lingering influence of Europe's presumed “cultural and moral superiority” at the height of its influence, according to Heraclides and Dialla – remains deeply rooted in the study of global health.

There is a Western focus on global health in terms of the data collection and presentation of global diseases. A major player associated with global health is the World Health Organization (WHO) and a glance at the WHO's webpage reinforces this idea. In the “Top 10 Global Causes of Death”, the breakdown for causes of death globally is almost identical to the breakdown for high-income countries. In contrast, diseases that plague low-income countries such as diarrhoeal diseases rank at an insignificant 9th in the global breakdown. Furthermore, another few leading causes of disease worldwide – also found to be most prevalent in high-income OECD countries – are mental disorders and substance abuse. An economist may see no issue with the data but from an anthropological point of view, the imposition of supposedly global health onto non-Western countries is worrying. This imposition seems to be a product of domineering countries defining global health, but it is still important to note the particular challenges faced when treating mental health in less-developed countries. Uganda's Health Services Strategic Plan (HSSP) states that there are many challenges to the mental health system in Uganda. Close to a third of the population live more than five kilometers from the nearest health facility and there is a poor public transportation system, which is mostly unaffordable to the people requiring it. Furthermore, there are 43 different languages in Uganda and despite their similarities, interpreters recognise that there may be significant differences in values and beliefs. For example, individuals find it difficult to share experiences with caregivers about sex, violence and traumatic situations associated with mental health even when linguistic and cultural diversity is bridged. These challenges may directly affect data collection for mental health. As such, despite the problem of Eurocentric data dominance in global health, it may not be due just to academic imperialism; other underlying factors in less developed countries may play a part as well. However, there is still an undeniable slant towards Western countries for global health. Whilst conditions like diarrhoea and infectious diseases cause fewer deaths, these conditions disproportionately ravage low income countries and simply placing it as a global cause of death not only obscures this fact, but also inhibits the institution of a more inclusive global health system.

In addition to the use of primarily Eurocentric data, Derek Summerfield argues that another problem with “global mental health” is the presumption that the Western notions and definitions of mental health can be translated into all countries. The biomedical models behind mental health rely heavily on Western social and economical situations; this context may not translate into the non-Western world which carry vastly different philosophies and standards of living. This is illustrated through a cross-cultural study of mental health beliefs and attitudes, in which Islamic ideology was found to stray from the Western diagnosis of mental distress, attributing them to supernatural causes instead. This anthropological view highlights the role culture and religion plays in both the diagnosis and treatment of mental health, negating the assumption that Western health models can simply be applied to every society. The impact of this Eurocentric lens on global health is reflected in the actions carried out by governments, non-governmental organisations (NGOs) and companies. The United Kingdom (UK) alone saw an increase of around US$2.5 billion in mental health research and services in 2018, as compared to the grand total of US$3.1 billion funding available for malaria worldwide. This disparity shows the ever-present influence of imperialism in today's world. It is important to consider that whilst there is significantly more funding for mental health issues in one country than the global outbreak of malaria, it is unfair to label this simply as imperialism. From a political point of view, it is not imperialistic for a country to prioritise their own perceived health issues. Similarly to the UK, Africa spends mainly on ailments that plague them – the budget for HIV/AIDS and Tuberculosis makes up the second largest proportion of Africa's healthcare budget. Despite this, it is still apparent that Eurocentrism comes into play in global health. The recent 2018–19 WHO Budget Programme, which proposes a decrease by US$5.7 million in the malaria budget and an increase by US$1 million in the mental health and substance abuse budget from the 2016–17 approved budget supports this from a funding perspective.

To conclude, Eurocentrism is undoubtedly commonplace in the research and funding that underpin global health, leading to conflicts arising between disciplines. As demonstrated, WHO presents mental health and substance abuse as worldwide phenomena even though they are primarily a problem in Western countries. This data presentation leads to Western definitions of health being imposed onto the rest of the world, disregarding non-Western culture and religion. Eurocentrism also sparks the debate between the disciplines involved in global health, as political and economical perspectives disagree with the imperialist evidence, yet anthropological studies acknowledge the presence of Western domination in global health, offering a different understanding of health in non-Western societies. Hence, Eurocentrism remains a pressing issue in the perception of global health.