https://orcid.org/0000-0003-3979-7603
ABSTRACT
Language – the words we use – can play a key role in enabling or limiting transformation of inequalities in the field of global health. At the same time, given the interdisciplinary, intersectoral, and international nature of much global health work, intended meanings, commitments, and underlying values for words used cannot be taken for granted. This commentary sets out to clarify, and in this manner render available for further discussion and debate, the phrase ‘critical and ethical global engagement’ (CEGE). It derives from discussions between scholars and partners in research, education, and healthcare practice based at one Canadian and two Rwanda institutions. Initially, our aim was to conceptualise the term ‘critical and ethical global engagement’ in order to guide our own practices. As the complexity of the values, commitments, and considerations underlying our use of this phrase emerged, however, we realised these discussions merited being captured and shared, to facilitate further exploration and exchange on this phrase.
Introduction
It is increasingly recognised that commitments to equity in global health are insufficient in and of themselves to interrupt and transform historically entrenched inequalities in the field of global health (Nixon et al., Citation2018; Plamondon, Citation2020). Doing global health work in a way that redistributes power – including access to material resources, evidence and education – requires recognising and actively working to revise normative institutional, interpersonal, and individual practices at the root of inequalities. Language – the words we use – can play a key role in enabling or limiting transformation of inequalities in global health. Words can naturalise privilege and power or serve as conceptual and practical anchors to facilitate social transformation. In this article, we propose a working definition of critical and ethical global engagement (CEGE). Our goal is to clarify meaning and implications for practice of CEGE, and to invite further commentary.
Our proposed definition of CEGE evolved from a process of consultation and scholarly debate designed to inform and challenge all instances of global engagement at a university in Ontario, Canada. In gathering as a multi-disciplinary knowledge community within the university, we sought to inform partnerships in research, education and advocacy involving academic institutions like ours, including their faculty, staff, students and partners.
Developing a definition of critical and ethical global engagement
Early attention to critical and ethical global engagement arose within our Canadian institution, Western University (London, Ontario), in relation to partnerships for research and mobility programmes and student exchanges that occur between sending and receiving institutions, and specifically students from the Global North participating in international learning experiences with partners in the Global South (Karim-Haji et al., Citation2016). We use the term ‘Global South’ in reference to countries predominantly located in the Southern Hemisphere with low overall gross-national product (Tiessen, Roy, et al., Citation2018). In recent decades, globalisation has become a pervasive force in shaping higher education (Altbach, Citation2007), with a resulting rapid expansion of internationalisation efforts and increased mobility and placements of students from the Global North in development health organisations or with community groups in the Global South. The mobility and international learning placement experiences are aimed at promoting international skill development, career enhancement, and thick forms of global citizenship. We define global citizenship as fostering an understanding of the moral obligations that follow from connections and linkages, as well as an understanding of the shared responsibilities in the realm of justice for all (Cameron, Citation2014; Feast et al., Citation2011). Global citizenship models responsible ethical behaviour (Dobson, Citation2006). However, while seemingly a noble cause, these attempts at global citizenship have been deemed to occur at the expense of host partners in the Global South (Tiessen & Huish, Citation2014). Scholars in this area agree that globalisation has placed new market-driven demands on universities, requiring them to assert their value in an emerging global education market for their economic sustainability, a pressure which brings to question the motivation for, and values behind, internationalisation (Altbach et al., Citation2010; Tiessen & Huish, Citation2014). This marketisation of education fundamentally affects students’ conceptions of what ‘doing good’ looks like and is often presented as self-improvement through charitable work (Hartman, Citation2016). This helping imperative or ‘desire to help’ is paternalistic and recreates stereotypes and ideas of Western superiority (Clost, Citation2014; Heron, Citation2007; Tiessen & Huish, Citation2014). Inattention to the political, historical and economic roots of inequality may result in reproducing colonial relationships and a charitable approach to service, which reinforces the power position of the global North to help the poor and less fortunate ‘Other’. Further exploration of internationalisation, and by extension education and research engagements between the Global North and South, is merited (Kiwanuka, Citation1988; Knight, Citation2008). Our initial interest in critical and ethical global engagement focused on expanding our understanding of how these practices are conceptualised and implemented; seeking also to understand their accountabilities to funders, institutions, host communities and the public good.
The urgency to articulate what we mean by ‘critical and ethical global engagement’ in education and research evolved, then, as a result of an initiative launched within our institution in 2018. The Health Equity Interdisciplinary Development Initiative (HEIDI) was designed to undertake local and international research activities in the areas of health and health-equity in community sites in both Canada and Rwanda. We operate as a collective of 38 faculty members (including researchers and university administrators), 24 students (including 8 domestic and international graduate students in Canada, and 16 graduate and undergraduate students in Rwanda), and 10 university staff in both Canada and Rwanda, alongside community-based collaborators in both countries. HEIDI members saw, early on, the value of establishing a common ground and orientation that would simultaneously respect individual and/or distinct disciplinary approaches to research. Although HEIDI members clearly share values towards health equity, it was appreciated that explicit articulation and implementation of these values might vary significantly. We are, as a group, diverse in our training (including ethics, health information, women’s studies, anthropology, public health, clinical epidemiology, nursing, medicine, health and rehabilitation sciences, literature, geography), with a range of contracts at the university (from precarious contracts to senior, tenured, full professors), and engaged in global health activities within and outside academia (research, education, advocacy), and within and outside our primary work base of Canada and Rwanda. Our group includes representations from diverse genders, sexual orientations, racialised identities, class backgrounds, countries of origin, lived experiences of colonialism and other forms of violence, and life trajectories. It seemed essential to take stock of each other’s understanding of a key phrase that defines the activities and goals of the group: ‘critical and ethical global engagement’.
The definition presented below is the outcome of a two-year iterative process of consultation with the full HEIDI membership and a smaller working group focused on issues of power and ethics in global health research, education, and practice operating in both countries. The authors started by hosting an in-person consultation on the occasion of the Canadian university’s Power & Global Health day in November 2019. Invitations to this convening were extended to HEIDI-affiliated graduate students and the 95+ researchers, instructors, and staff who had self-identified themselves in past years as involved in global health work at the university. Twenty-three individuals with representation from all faculties attended, generating rich discussion and a draft definition for CEGE. This work was iteratively supplemented by the smaller HEIDI Power & Ethics working group (with membership from both Canadian and Rwandan universities), and by discussion and reflection at full collective HEIDI meetings in 2019–2020. In this manner, we worked towards iteratively and collectively clarifying the terms that constitute this article. Pragmatically, our approach has been to problematise, expand and interpret our collective perspectives on the constituent parts of the phrase – that is the critical, ethical, global and engagement dimensions of our work. Along the way, we found multiple forms of nuance that disciplinary language and practical application of terms have lent to these words.
Constituents of critical ethical global engagement
Critical and ethical global engagement has many requirements and may be interpreted in myriad ways. Similarly, its constituent parts do not belong to – or get to be defined by – any particular group or discipline. In tracing the conceptual and definitional outlines of these terms, we do not claim them as fixed, but call for ongoing and wider discussion of these terms.
Tracing the boundaries of ‘engagement’ in context
We refer to engagement to encompass a range of research, education and advocacy activities in the context of university-community partnerships that involve representatives from both. Our discussion draws upon scholarly conceptualisations of engagement in the areas of participatory research (Cornwall & Jewkes, Citation1995), community-based or partnership research (Minkler & Wallerstein, Citation2011; Molyneux & Bull, Citation2013), and citizen involvement/participation (Beresford, Citation2002; GHRCB & HSPH, Citation2010). As a constituent of CEGE, while engagement itself may be focused on a global issue (i.e. one that does not necessarily have geographic boundaries), the character of the local context for all partners involved alters the nature of the engagement. Engagement is, therefore, always shaped by what each partner brings in terms of their local experience, including considerations of race, class, culture, discipline, history and ways of knowing. Our community recognises this local influence as essential: to harness it may be the raison d’être of engagement. In the context of global health, actions that aim to address global issues necessarily recognise and balance the knowledge of the communities involved, with practical and ethical implications. Engagement can be disempowering and harmful if knowledge is extracted without involvement, collaboration and control on the part of local actors. Other harms can include personal impacts, such as exploring difficult social experiences without appropriate supports, or terminating the engagement with no resolution or change to these challenges. The need for valorisation of diverse knowledges cannot be overstated – we propose that, if you are not valuing the knowledge of others, you are not engaging with them.
Further, we propose that the explicit and consistent commitment to valuing multiple, diverse and divergent perspectives, including those of persons most affected by an issue/problem, may be interpreted as a political commitment. It need not be lived or adopted as such, but certainly this is an approach that has the potential to counter historically normalised hierarchies of knowledge, including colonialist, androcentric and classist ways of thinking. A related enterprise is the questioning of assumed hierarchies of knowledge that define certain schooling, disciplinary background, forms of communication, and representation. While, in our positions, we do not deny the importance of higher education and training (and are subject to this valuing of our work, publications and role within academia), we propose that critical global engagement must challenge a priori assumptions that expertise and vision are limited to particular individuals or worldviews.
What do we mean by ‘global’ engagement?
Our process led to the broad agreement that global engagement is the bringing together of multiple ideas, strategies and perspectives with the goal of improving communities through reciprocal learning. ‘Global engagement’ means engaging with individuals, communities and institutions beyond our institution’s borders, with the aim of increasing wellbeing and the fair distribution of benefits resulting there from such activities, a position aligned with the fundamental aims of international development (Tiessen, Grantham, et al., Citation2018). While this perspective presupposes that all countries are in the process of development, and can therefore learn from one another, this use of ‘global’ does not negate the unequal distribution of Global South/North resources identified in relation to research and/or student mobilisation efforts.
Ethical dimensions of global engagement
Global engagement involves notions of right or wrong, whether or not these are made explicit: it reflects, or is motivated by, assumptions about what is important or of worth, and therefore is expressed in – and organised in terms of – shared values, beliefs, and relationships. To develop its ethical dimensions, global engagement requires that the values and beliefs informing it be made explicit, through a process that includes those participating in, and affected by, such engagement (Brock, Citation2009). While this stance precludes an established list of values to underpin activities, acknowledgement of the reality of global inequities makes the value of justice a central and normative aim. With this centrality in mind, we propose that the value of justice − traditionally understood in distributive terms as the fair distribution of burdens and benefits (Baylis et al., Citation2008; Miller, Citation2001; Smith et al., Citation2018) − is not a monolithic construct but one meriting discussion and collective agreement at each instance of application. We understand global inequities as remediable inequalities that are the product of structural arrangements (that is, differences in, e.g. health, income, power, etc.) that manifest globally between individuals and populations, and that are unjust. Such work entails multiple levels. At its core, it is a recognition that our commitment is not simply to the pursuit of justice among nations, but rather to the pursuit of justice among all human beings (i.e. to pursue what we as humans owe one another as a matter of justice) (Pogge, Citation2005). Substantively, it commits us not only to eliminating unjust disparities (e.g. in health, income, etc.), but also to working against global institutional structures that fail to give equal consideration to every human’s interests (Braveman & Gruskin, Citation2003; Pogge, Citation2005). Precisely what justice requires for critical and ethical engagement to occur ought to be critically and explicitly discussed amongst those participating in, and those who may be affected by, such engagement.
Dimensions and implementation of ‘critical’ engagement
The next logical question in our sensemaking related to what qualifies ethical global engagement as ‘critical’. On the one hand, critical refers to the commitment to challenge the status quo, conceptualising injustices as a consequence of unequal power structures, and working to change systems that perpetuate such injustices (Crotty, Citation1998). In the Rwandan context of our partnership, the critical dimension of engagement includes acknowledgement of colonialism by European nations, as well as of the current need for the Rwandan people to draw on their traditional ways of knowing in resolving their local developmental challenges while also learning from industrialised countries. The 1994 genocide against the Tutsi and the reconciliation process that followed in Rwanda is another determining factor of the context that continues to have influence on the ways Rwandans interact amongst themselves and with the world outside. Lastly, the long history of cultural and societal views of women as inferior, and the recent political move towards ensuring gender equality in Rwanda, represent a third area where tension and the potential for changing the status quo exists. That said, reflection upon our partnership contexts also raised important questions whether all communities are at a point where they can be freely critical and/or self-reflexive. For example, how can communities in non-peaceful settings expect to relate to others, and to the world, before they become resilient enough to relate to themselves? A community’s ability to define and valuate itself may be necessary before being able to enact critical engagement in the context of partnerships.
In the context of engagement in Canada, critical engagement begins with the explicit recognition of Indigenous peoples in this land, of their history, and of the legacies of colonialism that can be reified through various (uncritical) mechanisms. Consideration of other groups, such as people of colour, LGBTQ, and others experiencing other forms of oppressive conditions, must follow.
Consistent with this recognition of the multiplicity of perspectives and contexts involved, critical engagement involves the fundamental commitment to avoid ‘othering’ – namely, the objectification of another person or group, particularly where comparisons are made to other individuals, populations or countries in the service of reinforcing one’s own positive identity (Dervin, Citation2012). Writ large, because our construction and understanding of any given global issue will be intimately linked to our positioning (socioeconomic status, gendered, cultural, geographic, historical and institutional), avoiding ‘othering’ requires, as Kapoor (Citation2004) proposes, being unscrupulously vigilant.
But how to be ‘unscrupulously vigilant’? In our discussions, self-reflexive practice emerged as an essential mechanism to realise critical engagement. Reflexive practice involves examining our own assumptions, values, initiatives, and partnerships – and checking them against socially, culturally and historically situated ‘stories’ that define what is real, ideal (right), and knowable (de Oliveira Andreotti et al., Citation2015) – so that we do not inadvertently or deliberately neglect or reify existing inequities. As a community of Canadian and Rwandan researchers, we posit that if engagement in any global settings lacks critical reflexivity regarding power relations, it risks reifying western hegemony and itself perpetuates colonialism and global inequities. This perpetuation can occur in many ways, such as the cultural impact of imposing external value systems or the immediately tangible impacts of consuming the time and resources of global partners without reciprocity of input and gain. Such reciprocity may take many forms, including opportunities for non-academic perspectives to define how critique occurs. Consistent with our commitment to critical engagement that moves beyond thinking and theorising and into impact and change, we propose that listening to and amplifying those often-unheard perspectives is fundamental to critical engagement.
Discussion
Our process revealed a shared and ongoing concern with the living realities of this type of work. Much is yet to be learned about the implementation of critical and ethical initiatives, and we draw attention to three important areas in this regard: (1) sharing knowledge of mechanisms that work towards win-win engagement, from beginning to end of partnerships between Global North and South partners; (2) acknowledging and working with the respective limitations of all partners; and (3) resisting the gravitational pull towards one-size fits-all approaches.
In positing this approach to critical and ethical global engagement, we invite discussion of what it means to others, in other institutions and partnerships. We do not propose a solid definition, but one that raises multiple questions: What does it mean to practice critical and ethical global engagement? What does ethics in action look like, in the context of a global research partnership? How do these dimensions shift constantly and contextually? We suggest, as an area for future development, increased discussion of the deliverables and impact of critical and ethical global engagement, resisting certain metrics of success while also encouraging all partners involved to define what success means to them. In our experience, engagement can lead to reciprocal and multidirectional partnerships, knowledge translation and co-creation that does not merely reproduce the views of an empowered group, and diverse forms of bi-directional capacity-building and professional networks (Canas et al., Citation2021). Such questions and realisations cannot occur without ongoing reflexivity about one’s positionality and the political, historical, and cultural contexts of partnerships – a fundamental practice in this work.
Conclusion
Given the interdisciplinary and intersectoral nature of much global health work, we argue for the need to clarify and focus attention on guiding values, considerations and needs in the field. As a knowledge community sharing values and aims, we have endeavoured to make sense of ‘critical and ethical global health engagement’ in order to guide our own practices and that of others. We acknowledge this is the start of evolving work. In this invitation for commentary by the global research community, we call for further examination, discussion and evolution of this complex term.
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