Is Global Digital Health Becoming More Diverse and Equitable?

The U.S. experienced a racial awakening this summer with the death of George Floyd and subsequent racial justice protests. As the country grappled with long-overdue conversations on equity, diversity, and inclusion (EDI), many people turned a critical eye to their work environments. The global digital health field was not spared this analysis, as we started to ask ourselves, how equitable and inclusive are we really in the way that we do our work? Communities of practice within our space, such as the Global Digital Health Network and the Digital Health & Interoperability Working Group, began to discuss these questions and make changes to be more inclusive. The recent 2020 Global Digital Health Forum (GDHF) provided a platform where these conversations could continue, with several plenaries and panels on EDI scheduled.

I participated in one of these panel discussions, entitled “Reflection: Is Global Digital Health Becoming More Diverse and Equitable?” along with Amanda BenDor (PATH), who moderated, Carolyn Florey (International Rice Research Institute), and Derrick Matthews (UNC-Chapel Hill Gillings School of Global Public Health). The panel aimed to present various perspectives on EDI, such as gender, race, and sexual orientation, and critically discuss the field’s successes, challenges, and considerations for being inclusive in our work. The learning objectives of the panel were to discuss:

• the importance of diversity in global health and specifically in global digital health
• where we are making progress and where we are coming up short in gender, racial, regional, and sexual orientation diversity in digital health leadership and program implementation
• racism in the U. S. and its connection to racism and neocolonialism in the global landscape
• individual and organizational actions to foster a more diverse, equitable, and inclusive environment to support and inspire leaders in global digital health.

Having grown up in Kenya and immigrated to the U.S. for college when I was 19, I have a foot in two worlds, and nowhere is this more evident than in my work in global digital health. While I believe strongly in our work, sometimes I think we fail to acknowledge the diversity and agency of the people with and for whom we work. There is a tendency to treat sub-Saharan Africa as a monolith, to forget that people are different and have different needs, and too easily default to “one size fits all” solutions. Even when we espouse “designing with the user,” how often do we actually listen to the user? How often do we dismiss a person’s ideas or comments because they come with an accent we find difficult to understand, or from a woman, or from someone who was not educated in the global north? How often do we think that we know what users need better than they do themselves? Conversely, how often are we surprised when innovations and creativity come out of the African continent? How often do we condescend to our African colleagues, making them feel like less because even while giving them accolades, our paternalistic attitude toward them is evident? How much of these unconscious reactions and attitudes are influenced by neocolonialism and the dynamics of money and race?

While this summer instigated important reflections on how race plays a role in everyday life, I made the point in the panel that one should be careful not to conflate racial dynamics in the U.S. with race elsewhere. Again, it’s not a one size fits all approach. Africans experience race differently from Americans, and the solutions being put forward to improve things in the U.S. are not applicable to African countries. From my perspective, what is most insidious in our work is the correlation between race and resources. Does the American eye make an unconscious tie between the color of our users’ skin and their lack of resources? How does that unconscious association affect how we interact with our African colleagues and clients? How does the language we use when talking about our work (think “the field,” “capacity building,” “developing countries”) reinforce these neocolonial biases? 

My recommendation in the panel was to remember that Africa is a diverse continent with diverse needs. Diversity applies to more than race. We can’t assume that all Africans speak for one another, or that the context in a given area of a given country is the same in another country or even in another area of the same country. We’re all good people trying to do good work, so let’s listen, be open-minded, and help people solve the problems they have, rather than the problems we think  they have. This conversation is only just beginning, and there’s still a way to go, but it’s important that it has begun. I’m encouraged that we’re talking and thinking about these issues, and I look forward to seeing how much progress will have been made by the time we reconvene for GDHF 2021.

Written by Joy Kamunyori