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It’s All About Power – Young Global Health Professionals Reflect on PMAC 2024

By guest contributors Pauline Marie P. Tiangco, Kent Tristan L. Esteban, Alfredo Lorenzo R. Sablay & Kirchelle Ann Mae E. Nodado

We are four young aspiring global health professionals from the Philippines who were gifted with a rare opportunity to attend this year’s Prince Mahidol Award Conference (PMAC) held in Bangkok, Thailand this January 2024. Each year, PMAC gathers global health leaders, scholars, and advocates to deliberate on pressing issues confronting our world today. This year, PMAC focused on the theme, Geopolitics, human security, and health equity in an era of polycrises. This theme is indeed broad and complex, and we, as young learners of global health, definitely acquired new knowledge and insights on a wide array of issues, from global health governance to decolonizing knowledge production, among others. In this brief reflection, we decided to highlight three distinct yet interrelated takeaways as well as share our commitments for the way forward.

On Gender Inclusion and Equality

Gender inclusion is vital for fostering equality in health governance, policy, and decision-making. Thanks to the efforts of many organizations such as Women in Global Health and Global Health 50/50, we now observe increasing participation of women in different aspects of global health affairs. We wonder though about the next phase in our journey to genuine gender inclusion and equality.

During the plenary on “decolonizing global health,” one of this article’s co-authors, who identifies as transfeminine, posed a question to the panel: “When we talk about women, do we also consider trans women? And to go even further, what of the non-binary identities? Where are we in this decolonizing global health narrative?”

Her question, while acknowledged, did not receive a direct answer; there was also silence in the big conference hall. Maybe the global health community is not ready to tackle this neglected issue? Even during the conference synthesis on the last day, the participant profile presented was limited to the binary categories of male and female. We have a long way to go to achieving true gender inclusion and equality, even within our own global health sector.

If we want to influence the real world “out there,” we must begin having an honest conversation within our own backyard first – on who’s counted and who’s not. It is our hope that in future global health convenings, trans persons and non-binary individuals will no longer be invisible, and our direct questions will receive direct answers.

The authors with other members of the Philippine delegation having a moment with Dr. Agnes Binagwaho, former Minister of Health of Rwanda and one of the leading women global health leaders from the Global South

On Conflicts and Crises

We cannot talk about “geopolitics” without discussing the ongoing conflicts happening worldwide – Russian invasion of Ukraine, civil war in Myanmar, increasing tensions between China with Taiwan and the Philippines, and of course, genocide in Gaza. We global health professionals must strongly advocate for durable political solutions to end these protracted crises, but we must also continuously mobilize ourselves to address the health needs of affected populations, especially internally displaced populations and refugees, and the crumbling state of the healthcare system of areas in crisis.

During one of the discussions, Dr. Ghada Al Jabda, Chief of the Field Health Programme of the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), joined virtually from Gaza. She gave a moving personal account of the dire situation there.

“People are not numbers. People have families and dreams, and in Gaza, people, families, and dreams are being killed,” she said. It has been four months since the war erupted, and it seems we are forgetting Gaza more and more.

In global health, we often talk about the “social determinants of health” and tend to enumerate many of them such as poverty, education, and gender. What we rarely mention is that peace is a fundamental determinant of health – something that last year’s Lancet Commission on peaceful societies strongly emphasized. Health equity cannot be achieved without it. We global health community must contribute to efforts that improve the prospect of peace. Choosing not to be silent and speaking truth to power is an important first step.

On Commercial Determinants of Health

But when it comes to determinants of health, one type is increasingly becoming prominent in the global health discussions – the commercial determinants of health (CDoH). The CDoH sessions during PMAC highlighted challenges posed by multinational companies, economic arrangements like trade agreements, and even powerful countries with profound economic interests, as they promote products and services that are detrimental to health and the environment. One example presented was that of the commercial milk formula industry, which has been reframing infant breastfeeding as problematic, portraying it as a taxing endeavor for mothers and as an intervention with inadequate benefits for infants.

Meanwhile, Dr. Simon Barquera, Director of the Center for Research in Nutrition and Health of the National Institute of Public Health and President-Elect of the World Obesity Federation, shared the experience of Mexico, a country with some of the highest rates of obesity in the world. He talked about how politics, science, and civil society converged to produce forward-looking public health policies to counter the commercial determinants of obesity – such as taxes on sugary drinks and warning labels on the packaging of processed food. This story reminds us of what the Thais will always refer to as the “triangle that moves the mountain” in health reform – the combination of political will, scientific evidence, and social movements.

Some of the authors and members of the Philippine delegation with Dr. Simon Barquera, Director of the Center for Research in Nutrition and Health of the National Institute of Public Health

Dr. Nason Maani, a CDoH expert from the University of Edinburgh, also highlighted the importance of protecting the trade and investment regulatory space and shielding policymaking from industry interference or conflicts of interest. Ultimately, tackling the commercial determinants in the trade, investment, and fiscal policy space requires developing political savviness, overcoming naivete, and being able to navigate complex political spaces. As young global health leaders, we hope to build our competencies in these areas, as we interact more with these commercial forces in the future.

It’s All About Power

Advancing global health in this era of polycrisis is going to be very difficult in the midst of ignorance, interests, and injustice. Whether the issue is gender exclusion or geopolitical conflicts or commercial determinants, ultimately it is about the asymmetries in power manifesting within our societies, between countries, and among stakeholders. We left PMAC with deep concern about the future, but also a huge challenge for ourselves – to equip ourselves with the mindsets, tools, and skills that will enable us meaningfully contribute in the rebalancing of power and reshaping of our world.

Note: We thank our mentor, Dr. Renzo Guinto, Visiting Professor of Planetary and Global Health at our institution, St. Luke’s Medical Center College of Medicine, for his invaluable comments and guidance throughout the writing process of this blog – our first contribution to the global health discourse.

About the Authors:

Pauline Marie P. Tiangco, MD, MPH is a Research Fellow for Climate Change and Health Systems at the Planetary and Global Health Program of the St. Luke’s Medical Center College of Medicine. Her work focuses on building climate-resilient local health systems and advancing social innovations in health.

Kent Tristan L. Esteban is a Research Assistant for the Climate Change and Mental Health Team at the Planetary and Global Health Program of the St. Luke’s Medical Center College of Medicine. She is a strong advocate for mental health, climate justice, gender equality and empowerment, and social justice.

Alfredo Lorenzo R. Sablay, MD is a former Research Associate and Engagement Officer at the Planetary and Global Health Program of the St. Luke’s Medical Center College of Medicine. A staunch advocate of meaningful youth engagement in the Sustainable Development Goals, mental health, and universal health care, he was a recipient of the Diana Award 2022 and the ASEAN Youth Organization PH Outstanding Community Development Advocate and Frontliner for 2023.

Kirchelle Ann Mae E. Nodado holds the position of Research Associate in the Climate Change and Health Systems at the Planetary and Global Health Program within the St. Luke’s Medical Center College of Medicine. She is also currently pursuing her Master’s degree in Health Social Science at De La Salle University.

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

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