How not to become a global health expert – Speaking of Medicine and Health – PLOS

By guest contributor Chiamaka Precious Ojiako

There is neither a universally accepted definition of global health expertise nor credentials, checklists, or guidelines on how to become a global health expert. However, the definitions of expertise provide useful hints. Swanson defines expertise as the optimal level at which a person is able and/or expected to perform within a specialized realm of human activity. According to Herling, human expertise is a displayed behavior within a specialized domain in the form of consistently demonstrated actions of an individual that are optimally efficient in their execution and effective in their results. From these definitions, optimal performance, consistency, competence, and execution are indispensable for becoming an expert.

The absence of established credentials for becoming a global health expert is both a blessing and a curse. On the one hand, global health is a beautifully interdisciplinary field, drawing on knowledge from communities, medicine, policy, and more this flexibility accommodates unique paths, contextual factors, and the evolving nature of global health practice.

On the other hand, the lack of consensus on what makes a global health expert has created global health experts by default, based on a health professionals nationality or country of residence, resulting in an uneven skew of global health experts from high-income countries. This skewed distribution perpetuates a history of colonialism and exploitation that elevates access to resources and branding as key factors for developing expertise rather than experience and competence. Furthermore, it has excluded health professionals in the Global South and caused them to be hesitant about declaring their expertise even when they are in the proper sense.

For those of us working in the field of global public health, it is therefore pertinent to understand that you are not a global health expert because you got a graduate degree from a prestigious college or university without prior experience; travelled to a village in an LMIC for a week or a year for an internship or project; worked with a nonprofit with a global health focus or a global health organisation for more than a decade; or are fluent in English. This has been the subject of many vibrant conversations regarding expertise, so I reached out to health professionals to get their perspective on what makes a global health expert.

Lazenya Weekes-Richemond, a global health practitioner, said that the traditional definition of a global health expert is a White Westerner who studied global health at a prestigious university in the West and is working on large-scale public health projects to improve the health of people in LMICs. This definition is problematic for me, as it erases and undermines the lived experiences and deep contextual knowledge of people living in LMICs. For me, the true global health experts are those with lived experiences of health inequalities and proximity to health issues affecting their communities. They are the unpaid community health workers who go from house to house to check up on their patients; the midwives at the rural health post who work round the clock to give care to laboring women; and the district health officer who drives hours on their motorbike to provide bedside care. These heroes may not have the academic degrees behind their name, but they are passionate and continue to serve their communities long after the donor project funding dries up and the Western global health experts move on to another flashy donor project.

Jonathan Ajah, a UK based Nigerian Academic, Physician & Health Tech Innovator, equally finds the recent trend of self-acclaimed global health expertise concerning and erroneous and believes that most true global health experts neither profess nor self-acclaim. In reality, global health expertise is really a journey of education, field experience, real-life problem solving and giving back in some meaningful shape or form.

Marie-Claire Wangari, a Kenyan General Practitioner, aptly explained the double standard in becoming a global health expert by stating that There is no one size fits all when defining who a global health expert is. Every health issue a person interacts with is a global health issue and the Global South houses most of the global health problems worldwide. The sad part is that if I, a young Global South thought leader, proffers a solution or insight on a solution for my people, based on things I have seen, I will most likely need to provide academic papers and evidence to substantiate my claim and prove my credibility. Conversely, if the same solution emanated from someone in the Global North, the person might not undergo the same level of scrutiny because their systems are more trusted. This is one reason so many brilliant research papers emanate from the African continent, albeit with little visibility. I think it is time to acknowledge that experts do not fit in one particular framework and that the Global South is indeed home to some of the top Global Health experts.

Ascribing global health expertise for unsubstantiated considerations has grave consequences on health outcomes and the attainment of global health goals. Highly qualified health experts in the Global South are sometimes subjected to lower paying roles with more workload, leading to low morale. Also, prioritizing showmanship over content by sidelining health professionals with ground experience and deep knowledge of communities equally jeopardizes peoples health.

So, this brings us to the question: what constitutes global health expertise, and how can one acquire it? I would argue that a way forward is to follow who know road as my fellow Nigerians say, which means mimic the success journey of others. Hence, if you desire to become a global health expert, focus on acquiring knowledge, developing skills and competence, creating value, and being visible.

Visibility is an area several professionals from LMICs fall short. Brenice Duroseau, an infectious disease nurse practitioner and emerging sexual reproductive health scholar, opined that structural systems of oppression, intentional gatekeeping, and power dynamics contribute to the limited construct of global health expertise. Many currently recognized global health experts continue to gatekeep by not extending community members publication opportunities, even though publications are social and professional currencies. By gatekeeping publication opportunities, these experts are securing their positions, while contributing to the marginalization of those most impacted and often exploited. Additionally, paternalistic approaches to research disempowers these communities and positions those from resource rich settings, as the ones who have all the answers to complex problems even when they are unaccustomed to the context. In the pursuit to decolonize global health, we need to be intentional about including and recognizing those from the communities as experts.

The visibility gap is rectifiable by publishing thought-leadership pieces, articles, leading panels, and networking actively and strategically. People can only know what you are doing and appreciate your contributions when you are on their radar. Be humble, prove your salt by solving difficult problems, remain a constant learner, and be open to feedback and dissenting opinions. Also, be comfortable being uncomfortable because the journey to developing expertise in global health may require walking lonely paths and being the odd voice in the room.

Expertise in global health is not attained by wishful thinking or declarations on social media headers or timelines. Aspiring to become a global health expert is a goal worth having and not everyone desires it, but if you do, be prepared to go beyond speaking it into existence by taking deliberate steps to build expertise.

About the author:

Chiamaka P. Ojiako is a lawyer and health policy professional with diverse work experience in the public, nonprofit and international development sectors. She has an MPA in Health Policy and Management from New York University. Her work is at the intersection of law, research, policy analysis and advocacy, with a focus on addressing health system governance gaps and fostering health equity. She can be found on Linkedin and Twitter @FavouredAmaka

Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.

More:

How not to become a global health expert - Speaking of Medicine and Health - PLOS