A New Narrative for Global Health (continued)

Katri Bertram

March 1

Some thoughts on what a new narrative for global health could entail - and why a narrative alone is insufficient for real impact.

Thanks to everyone who has sent such kind feedback on my previous post on the need for a new narrative for global health. A few further reflections on what I think is needed, and one important caveat upfront:

Narratives don't change lives - actions do. Although I am not a communications specialist, I have (co-)authored and overseen global health narratives in various roles throughout my career. A narrative is an articulation of what you are showcasing: a destination, a path how to get there, scene-setting on where you are starting out, and descriptions of who is traveling. A compelling narrative shows what really counts, and touches hearts and minds (and as my fabulous colleague Helena Legido-Quigley has added: wallets). Narratives can be inspiring, eye-opening, and they can help reframe what and who is needed. Yet they can also remain stories, fully disconnected from action and reality (i.e., aspirational or deceptive fake news). In the worst case, they can distort and oppress (e.g., colonial, racist, or patriarchal narratives).

In short: a new narrative will not change global health - nor will it lead to more impact. Only actions can do that.

However, I also believe that if we do not have a new global health narrative - ideally one shared and authentically supported by most of our community - we will make ourselves irrelevant. As I have written before, many of us primarily publicly parrot what we're being paid for (in salaries or carrots). Privately most people agree we need something different - even to touch wallets, not to mention minds or hearts. Increasingly, anger against the status quo in our sector is erupting, and more and more people are going public with alternative health agendas (and narratives). This is a good thing, because we need to debate what is needed, and come to a collective understanding. Right now, disrupting the status quo and dominant narrative is still taboo. And that's not acceptable. Global health is not - it cannot be - authoritarian in culture and practice if we want to help deliver health for all people.

A new narrative has to be underscored by our sector's willingness to change. As I wrote in my previous post, what may have worked in the past (MDG era) is no longer working (in the SDG era and especially now after the peak pandemic). A new narrative can only add meaning if we are willing to walk the talk and change our actions. Not everyone will be willing to change (those who benefit from the status quo will push back), but those of us who believe change is needed are a growing, stronger force, and can no longer afford to remain silent or on the sidelines.

Here are five priorities I think are needed for a new global health narrative:

Begin with what people and countries say they need. It is unlikely they are asking only for the current, select, medicalised silver-bullet solutions and ODA-dependent funding and voluntary donation-based mechanisms we have.
Don't shy away from complexity and systems. People are not stupid. Don't try to sell them simple fixes and donations when they know that health requires much more (financial protection, health workers and health infrastructure, protection from harmful environments and determinants, domestic and local systems and sustainability).
Focus on health and not just survival. Our sector is called global health. SDG3 was envisioned as global health and well-being. Why do we still mainly focus on mortality and survival (and even that only for narrow diseases and causes)?
Act transformationally. We are great as a sector at adding big words to our narratives (e.g., sustainability, equity, future-proofing), yet the path we take with our actions doesn't lead even close to these destinations (sometimes the contrary). An authentic narrative must sketch out a realistic path we are willing to take - all the way.
Listen and adapt. The world is not a static place, and people's needs change. Just because something was needed and worked before doesn't mean it is what is needed now, or in five or ten years.

As always, all feedback is more than welcome. And if you have new global health narratives to share, please do add these to social links - or share a google doc with a better one...