Lectures

Conference Report: Social Medicine from the South

(On behalf of the Wellcome Trust Global Social Medicine Network)

Introduction

Social Medicine from the South was a virtual two-day mini-conference consisting of two panels that took place on Friday 26 March and Monday 29 March 2021. The event was organised by the Global Social Medicine Network, a Wellcome Trust funded network of scholars from around the world who are committed to a vision of social medicine as the vital intersection of social sciences, medical practice and policy. This conference was part of the Network’s goals to re-imagine social medicine, showcase the diversity of approaches to the field and facilitate a global conversation to change the social and economic conditions that structure health inequalities.

The organising team included Michelle Pentecost (King’s College London/University of the Witwatersrand), Helena Hansen (UCLA), David Jones (Harvard University), Junko Kitanaka (Keio University), Francisco Ortega (Catalan institution for Research and Advanced Studies/ Universitat Rovira i Virgili, Tarragona), and Jeremy Greene (Johns Hopkins University).

Two questions formed the provocations for the conference: What would it mean to make the so-called ‘South’ the location from which we enter a conversation about social medicine? And, conversely, what would it mean to make social medicine the location from which we enter a conversation about the ‘South’? These questions were born out of the Global Social Medicine Network’s recent publications in Global Public Health (Adams et al., 2019) and The Lancet (Pentecost et al., 2021).

Scholars from around the world and from a variety of disciplines shared their perspectives about what social medicine from the South means to them. The first panel consisted of Tinashe Goronga (Centre for Health Equity Zimbabwe), Mindy Fullilove (The New School), Rama Baru (Jawaharlal Nahru University) and Kenneth Camargo (Rio de Janeiro State University). Panel two included Zhiying Ma (University of Chicago), Cristian Montenegro (Pontificia Universidad Católica de Chile), Eugene Raikhel (University of Chicago), Wen-Hua Kuo (National Yang Ming Chiao Tung University) and Omar Dewachi (Rutgers University). The panels were followed by a Q&A, where the audience and panellists participated in a discussion together.

There are many different social medicine movements around the world and these movements share the common principle that medical science and practice are inextricable from their social and cultural contexts. Despite the diversity of social medicine movements, some traditions have shaped global imaginaries more than others (see Pentecost et al., 2021). The Social Medicine from the South virtual conference showcased a diverse social medicine conversation about how to re-imagine social medicine in the future.

Social medicine in the ‘South’

The conference’s invitation to enter conversations about social medicine from the ‘South’ and, conversely, conversations about the ‘South’ through social medicine, was a useful provocation for thinking critically about a genuinely inclusive global social medicine. Tinashe Goronga observed that while it is clear that ‘North’ and ‘South’ have long operated as descriptors of colonial and postcolonial relation, we might now summarise that the South is ‘where the data is’, a model that sidelines Southern scholarship. Building on Goronga’s critique, Mindy Fullilove spoke of the so-called ‘Fourth World’ of deprived communities in wealthy, industrialised nations, where imperial relations and practices happen within borders to replicate land theft, degradation and racism, with consequences for health inequalities. Rama Baru described the global South as a transnational idea, arguing that the South should be thought of as a set of attitudes and practices rather than a specific geography. This argument was taken up by Wen-Hua Kuo who asserted that the South was a “process” in social medicine, operating through relations between public health, health policy and science diplomacy, inviting capital, agents and actors to be productive. He argued that the South could also be thought of as a “method” for social medicine – helping to make visible what is missing in the promise of health on a global scale. Kenneth Camargo gave a detailed history of the development of collective health in Brazil, which he described as a complex field comprising the production of knowledge and direct intervention in health matters, encompassing health policy, planning and management, epidemiology and social science and humanities in health, with an emphasis on critical thinking. Zhiying Ma described her latest project – a community-based participatory approach to develop a peer support program that highlights the voices and lived experiences of people with mental illnesses in China. Ma noted the variegated ways in which citizenship is imagined, granted, achieved or denied. Using this example, she argued for acknowledging the material impact and symbolic legacies of world-historical processes, such as the idea of the Chinese family, as well as incorporating theories of health, illness and disability from the South into research. This in turn translates and transforms global discourses, including recognising and rethinking power dynamics and knowledge production in academia. Omar Dewachi gave a detailed description of conflict medicine in the Middle East. He noted that the Middle East has often been absent, and even silenced, in global discourses and histories of social medicine, despite having an important contribution to share. He attested to war being a global health crisis and the need for it to be recognised as such. War and conflict medicine is social medicine and cannot be excluded from discussions about the ‘South’. By considering examples from a greater variety of contexts and geographies, we can re-imagine what constitutes social medicine to better meet the ultimate goal of reducing inequalities.

Re-imagining social medicine from the ‘South’

Questions about how to put the lessons of social medicine from the ‘South’ into action were frequently considered in presentations and in the Q&A. Two primary methods were discussed, including having a greater focus on social medicine in medical education and rethinking scholarly infrastructure to dismantle power dynamics. This conference asserted that the ‘South’ can be found everywhere and be used as a concept to rethink our approach to social medicine, but for these ideas to make an impact on the field, a variety of scholars, including those from the ‘South’, must be included in discussions. By increasing access for scholars from a wider variety of research contexts we can build a richer field of global social medicine.

Medical Education

The first panel raised questions about how to apply lessons from social medicine to medical education, in particular. Goronga described a number of ways his foundation in social medicine makes him a better doctor, including unlearning the precepts of Western supremacy in medical education, listening to communities to reveal one’s own biases, and the ability and willingness to explicitly critique institutions, neo-liberal structures and the legacies and contemporary operations of colonialism. The “social” is often excluded from conventional health and public health discourses on the ‘South’. Goronga contends that health cannot be separated from the historical and cultural context of the ‘South’, which has been so heavily shaped by structural inequalities.

Dewachi and Fullilove each discussed the medical curriculum itself. Dewachi described how, across the Middle East, colonial legacies and the neo-colonial culture of medical accreditation have limited opportunities for continued learning. Further, Dewachi argued, medical school curricula often fail to reflect the needs of the local environment and must be tailored to the realities of place. Fullilove described a method for connecting medical students with their local environment and community by performing a “stroll ‘n’ scroll” as outlined in her book, Main Street (Fullilove, 2020). During a “stroll ‘n’ scroll”, students walk a main street within their neighbourhood and reflect on what they have seen by creating a ‘scroll’ of writings and illustrations or photographs. This simple exercise can contribute to a deeper understanding of the issues communities face, both personally and for others who read the documented observations. Key to these suggestions of changes to medical education is giving people the chance to connect to their community and better understand their place within it.

Rethinking Scholarly Infrastructure

Panellists touched on the need to rethink our approach to the scholarly infrastructures that can so often exclude social medicine from the ‘South’. Fullilove discussed the pioneering University of Orange, which offers universal, lifelong, free education and is based on the philosophy that “everyone has something to teach, and everyone has something to learn”. Learning from the global ‘South’ was essential in building the pedagogy of the institution, including “naming the moment” and “popular education”.  Inspired by Brazilian scholar Paulo Freire’s critical pedagogy, the university runs a reading group, where the aim is to have a lively and informative session which is not predicated on whether participants have read the book. This Southern-inspired ‘popular education’ initiative is helping to break down barriers to education in Orange, New Jersey.

In academia, Cristian Montenegro outlined the Platform for Social Research on Mental Health in Latin America (PLASMA). The platform was set up by a group of PhD students with projects on mental health in Latin America. The group noticed that Latin America was not part of the conversation on global mental health, and there were very few researchers from this region included in publications. This led to a notional gap in global mental health, where the realities of only a limited number of places had been considered. Social scientists had also only had a very limited role in the field, contributing to a lack of contextual depth to research. PLASMA offers a space to consider global mental health from the perspective of social medicine, opening up this field to scholars from more geographies and disciplines.

Eugene Raikhel brought forward a similar experiment in scholarly infrastructures and social medicine from the global South. Somatosphere, a collaborative online platform, is breaking down barriers to academic publishing. The site shares its values with the open access movement, which is dedicated to “fostering respect and care for divergent communities of scholars” and paying attention to the “inequalities that are fundamental to disciplinary lineages, material conditions…and the economies of citation, prestige and affiliation” that continue to make social sciences of health and medicine hierarchical and exclusionary (Appleton et al., 2018). Collaboration and the establishment of scholarly relationships are key to creating a more inclusive academic environment. Somatosphere has worked hard to bring together scholars from the North and South in publications (Durham and Awah, 2020) and is making efforts to increase the diversity of  their editorial board. By recognising, and working to reverse, the structures which have for so long made academia out of reach for people from certain backgrounds, we can reflect a truly global approach to social medicine.

English language: exclusionary or collaborative?

Language was a topic many audience members were keen to discuss, including whether it was appropriate to expect Southern scholars to publish in English, or if this was an exclusionary practice. Eugene Raikhel pointed to Somatosphere’s reviews of books published in languages other than English and highlighted a recent paper which was published in both English and Portuguese, with the Portuguese version first, helping to open up the world of Southern scholarship to a Northern audience. Wen-Hua Kuo has established the journal East Asian Science, Technology and Society: An International Journal (EASTS), which champions social medicine from an East Asian perspective and publishes abstracts in both East Asian languages and English. The first issue of the journal included a debate on why the journal was published in English at all, noting that using English enables scholarship to cross the boundaries between different countries in East Asia.

Cristian Montenegro advocated publishing literature reviews in English of social medicine research originally published in other languages to achieve greater recognition of the contribution non-English traditions have to the field. Montenegro argued that publishing in English is a way to deconstruct the notion of Northern superiority in knowledge production, allowing for collaboration and greater appreciation of the vital scholarship on social medicine and collective health from the ‘South’.

Conclusion

‘Social Medicine from the South’ provided an encouraging use of the digital medium to put in conversation several important and geographically separated strands. Speakers explored what the global ‘South’ means to them and outlined how the ‘South’ is more than a set of nation states, rather being a transnational idea. Doing social medicine from the ‘South’ means going out into communities to hear what health means to them, it means breaking down the hierarchies that have for too long made academia an exclusionary place, and it means embracing collaboration between scholars from different regions and different disciplines to build a better world.

The Global Social Medicine Network thanks all the panellists and attendees for making this such a valuable event. The network looks forward to putting some of the sentiments into practice in our Social Medicine Writing and Publishing Workshop for early-career researchers from Latin America, and in future events.

Works Cited

Adams, V. et al. (2019) ‘Re-imagining Global Health Through Social Medicine’, Global Public Health, p. Online. doi: 10.1080/17441692.2019.1587639.

Appleton, N. et al. (2018) ‘Respect, care, and labor in collaborative scholarly projects | Somatosphere’, Somatosphere. Available at: http://somatosphere.net/2018/respect-care-and-labor-in-collaborative-scholarly-projects.html/ (Accessed: 11 May 2021).

Durham, E. and Awah, P. K. (2020) ‘Introduction: Working Definitions: Making and Unmaking “Medical Anthropology” around the World | Somatosphere’, Somatosphere. Available at: http://somatosphere.net/2020/working-definitions-medical-anthropology-introduction.html/ (Accessed: 11 May 2021).

Fullilove, M. T. (2020) Main Street: How a City’s Heart Connects Us All. New York: New Village Press.

McCord, C. and Freeman, H. P. (1990) ‘Excess Mortality in Harlem’, New England Journal of Medicine. New England Journal of Medicine (NEJM/MMS), 322(3), pp. 173–177. doi: 10.1056/nejm199001183220306.

Pentecost, M. et al. (2021) ‘Revitalising global social medicine’, The Lancet. Elsevier. doi: 10.1016/S0140-6736(21)01003-5.


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