A Covid-vaccine mustn’t be hoarded.

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On July 20, researchers at Oxford University’s Jenner Institute released preliminary Phase I data on the immune response of their vaccine candidate, ChAdOx1 nCoV-19, in The Lancet. These findings are helpful and bring a glimmer of hope that perhaps a vaccine could be found to prevent (severe) COVID-19, caused by the virus SARS-CoV-2. On the same day the World Health Organisation (WHO), cautioned the world that indigenous peoples in the Americas, the current epicentre of the pandemic, are particularly vulnerable to the virus and its severe ramifications. This only strengthens the urgency with which we must avoid hoarding a potential vaccine or treatment for COVID-19 away from the most vulnerable in the world.

As we have seen over the last months, this virus and the disease it causes does not hit every one of us equally. The epidemic’s epicentre has shifted from China to Europe, and is now currently in the Americas. What we have seen is that many vulnerable people have borne the brunt of the pandemic, with the burden of mortality mainly shouldered by minoritised and racialised communities in Europe and the United States and key workers in general (many minoritised and racialised communities are also more likely to be frontline workers), as well as those with lower socio-economic backgrounds. As mentioned in the previous paragraph, Dr Tedros, the Director General of the WHO, has recently mentioned how indigenous communities in the Americas are currently most at risk of suffering the effects of the Covid surges throughout the continent. Presently, the spike in SAR-CoV-2 infections in recently contacted indigenous peoples in the Amazon have raised alarm. Furthermore, although some countries with weaker health systems have seemingly been able to relatively contain the virus, it has nonetheless been a terrible strain, especially in countries that are also still dealing other communicable disease outbreaks such as a recent Ebola and measles outbreak.

Recently, the United States bought up most of the world’s supply of Gilead’s remdesivir which, other than the drug dexamethasone, is currently the only hopeful candidate treatment for COVID-19. Even though there is as of now limited evidence for remdesivir, and the cheap drug dexamethasone at time of writing seems more promising, the move by the United States sets a worrying precedent.

As I have stated so many times on this blog, health is a human right. To ensure accessibility and equity in healthcare we have to act accordingly. When countries with relatively strong healthcare systems and strong scientific infrastructure to research and produce vaccines and medicines to prevent or treat COVID-19 end up distributing, or even hoarding, these vaccines and treatments for their own populations, there is a strong possibility that countries with disadvantages, many incurred because of a history of colonialism and extractive capitalist exploitation, will end up holding the metaphorical baby. Within these countries the poorest and those made most vulnerable (including indigenous peoples) will suffer the most. Beyond vaccine hoarding, the selling of vaccines or treatments for profit by pharmaceutical companies will also disadvantage the world’s poorest and those in (mainly) Global South countries. Moreover, there are some concerns that neocolonial approaches to vaccine and medicine testing will end up using the African continent as testing ground.

Dr Tedros has reiterated in the daily briefing that a potential vaccine should be a public good. It must be continually emphasised that access to healthcare is a basic human right. Many countries have pre-existing issues with being able to reach their most vulnerable communities and provide them with appropriate healthcare, and while the pandemic has exposed the vulnerability of all of our health systems, some countries and some people will be more disadvantaged than others. It is imperative that countries with more advanced health systems do not return to an ‘each man for himself’ mentality, but act in the spirit of solidarity.

A post-Covid world could – indeed should – be one where healthcare is accessible, health is treated as a human right, and our approach to global and public health is one of internationalism and solidarity.

A vaccine or treatment must be freely accessible to all people. The importance of healthcare as a human right must underpin every step our governments take moving forward. The pandemic has shown us that in an increasingly connected world, our health systems are really only as strong as the weakest link. In a neoliberal capitalist world it is progressively common to see everything, including our human rights, through the lens of profit margins and winners and losers. Austerity, the privatisation of healthcare, and growing inequality have direct impact on global and public health. We cannot, then, in good conscience apply the ‘logic’ of the market to a global pandemic where many vulnerable people are needlessly losing their lives and suffering. A post-Covid world could – indeed should – be one where healthcare is accessible, health is treated as a human right, and our approach to global and public health is one of internationalism and solidarity. What better way to laud in the new world than to use these principles as the way out of the pandemic? What better way to increase equality, health access and diminish the possible catastrophic effects of a next pandemic than to work together to make vaccines and treatments freely accessible? It is not just a nice thought; I would go as far as to say that this is our moral duty. The time for complacency is over and the time for solidarity is now.

The shakiness of our foundations.

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Karl Marx wrote that ‘the history of all hitherto existing society is the history of class struggle’. To many people the idea of class struggle seems archaic and belonging firmly to the 20th century. An equally 20th century idea is that of living through a deadly pandemic – a scenario that has for most of us only been conveyed through history books, and a scenario in which we have collectively been thrust by the once-in-a-century unprecedented COVID-19 pandemic. This current pandemic is exposing the problems within our current economic and social systems, and most importantly exposes the fragility of the human right to health. It turns out that the emperor is naked.

Inequalities in access to healthcare between Global North and Global South countries have, rightfully, long been the focus of conversation surrounding global health. Soon after the WHO declared a public health emergency of international concern (PHEIC), the Director General, Dr Tedros, pointed out that this virus could be most lethal and dangerous for countries with weaker health systems, largely (though not uniquely) corresponding to the Global South. Beyond ‘developing’ and conflict-heavy countries with weaker health systems, the current pandemic has exposed the health inequalities that exist within the Global North as well. In many Global North countries, in the years after the crashing down of the neoliberal order, austerity (to varying degrees) has been the go-to policy with public sector jobs being cut, and many people being thrust into unemployment and even poverty. This has had many consequences on health (both mental and physical) and has caused many of our countries to be woefully underprepared for something as catastrophic as a pandemic.

In recent weeks, governments have been calling on ‘essential workers’ and their skills. Many people across the world have been applauding their healthcare staff from their windows, balconies, living rooms and their palaces. We have, rightfully, been supporting ‘essential workers’, but what does that mean when essential workers have been devalued for years within our societies? When many of the people we have elected have been the ones to systematically cut funding for healthcare and the minimum wage is still not necessarily a living one. Many essential workers are in low-paying jobs, and additionally many essential jobs are traditionally feminised roles such as caring professions and domestic and service jobs. This exacerbates already exiting inequalities where they exist.

One of the most effective ways to slow the spread of infectious disease is through social – also called physical – distancing measures such as working from home, staying at home as much as possible, and avoiding close physical contact with other people not part of one’s household. However, for many people, many of whom economically disadvantaged and/or marginalised, this is nearly impossible, increasing the burden of mortality for this group. For many these people working from home is impossible because of the nature of their jobs, staying at home would mean a loss of income and livelihood, and there is a lack of paid sick leave and no (affordable) available childcare.

But beyond income inequality and depletion of resources for many of our health services and the low-wage nature of many essential jobs,, there are other vulnerable groups who will be suffering from increased difficulty in accessing healthcare during the pandemic. An example of this are the homeless who will not have the opportunity to social distance in the same way those with a home do, and who will often not be able to access quality healthcare as easily. Another example of a vulnerable group who might experience more difficulty are prisoners. Prisons are often not adept at containing major infectious disease epidemics. Thirdly, immigrants and refugees who are currently living in dire conditions in camps and settlements, particularly as these people will likely live in crowded places with poor sanitation and more difficulty to access healthcare. Beyond the elderly and those with underlying conditions, there are so many other people who might be particularly at risk in this time. Many of whom have been neglected by society, but all of whom are particularly at risk of having their human rights abused.

This global pandemic has shown us that, even though health is a human right, it is only as viable and attainable as the strength of our health systems and our care for the most vulnerable in society are.

Health is a human right as recognised in the Universal Declaration of Human Rights. The decade of systematic cuts to our health systems and the secondary effects of austerity of thousands of people working in precarity and dealing with failing living standards have caused us to be woefully unprepared for a catastrophic event like this. This global pandemic has shown us that, even though health is a human right, it is only as viable and attainable as the strength of our health systems and our care for the most vulnerable in society are. In a world where the rich are able to self-isolate in mansions or second homes, and get access to tests even when others can’t, it seems difficult not to imagine there might be an aspect of class strife involved. It seems clear that we won’t be able to return to normal after the pandemic is over. The shaky foundations our systems are built on are not likely to survive in tact after this. It is then up to us to decide what’s next and to prepare for the next pandemic – which will come – in more comprehensive ways such as defending the right to healthcare, increasing its access, funding our health systems, implementing fairer labour policies, and redistributing wealth. We must applaud our essential workers, but we must also not forget them when this pandemic is over and they ask for more than just verbal appreciation. We, after all, are only as strong as the weakest link and at the moment the tower is crumbling.

Health in the Time of Disaster.

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Hurricane Dorian ravaged the Bahamas, and is set to make landfall in the United States. A hurricane, in itself not extraordinary during this time of year, that has undoubtedly increased in ferocity due to the changing climate. Humanitarian crises and disasters like these will only increase in frequency as well as intensity as time goes on. As we reckon with what the consequences of a planet heating beyond repair would mean, the question of what it will mean for our human rights, and in particular the human right to health, remains under-explored.

Perhaps the most obvious consequence of the increase and violence of natural disasters, is the fact that it will be more and more difficult to physically reach the people affected, affecting their accessibility to healthcare. Indeed, an increase in humanitarian crises will mean that more people will have difficulty accessing clean water, food, and medicines,  and will be more at risk of developing infectious diseases. Unsurprisingly, the most vulnerable and poorest populations, both within countries and between countries with the Global South more affected than the Global North in this respect, will be hardest hit when disaster strikes. The vulnerable and poorest being hardest hit means that they will be likeliest to need medical assistance, and simultaneously means that it will be harder to reach these communities. This is a bind that most, if not all, healthcare systems are likely not sufficiently prepared to tackle, but it is already a reality for many people around the world.

As briefly mentioned in the above paragraph, another consequence of a global rise in temperature is the increase in infectious diseases and parasites. The global rise in temperatures will likely make previously uninhabitable parts of the world for parasites more attractive to them, and they will increasingly appear where they would normally not be found.  In addition, water scarcity as a result of drought can lead to poor sanitation which will increase the incidence of diseases such as cholera. Again, unsurprisingly the people bearing the brunt of these issues are poorer communities in the Global South. 

Beyond communicable diseases, mental health issues are an under appreciated consequence of the global climate emergency. ‘Ecological grief‘, a sense of grief borne out of the changing ecological landscape, and a loss of a way of living, seems to be particularly felt by people who live in synchrony with nature. Indeed, indigenous communities, like the Greenlandic Inuit, have increased mental health issues related to a loss of their way of life, their ability to live with nature and off of nature. Voices of many indigenous communities who have been losing their land, their livelihoods, and their ability to live in synchrony with their ancestral lands are rarely heard, but the climate catastrophe has dire consequences on their mental health. Ecological grief, ties together the climate crisis, mental health, and indigenous rights. In general, a sense of climate despair seems to be affecting people’s mental health across the world, making many people question the point of existence as a sense of hopelessness about the situation takes over. Whether our mental health services, especially in a world where there are not an awful lot of mental health professionals, are capable of rising up to this challenge remains uncertain.

Health, whether physical or mental, communicable or non-communicable, is a fundamental human right that is under pressure in a changing world.

The United Nations rapporteur on human rights and extreme poverty, has said that human rights might be threatened due to climate change. The world’s wealthiest might be able to escape the worst of climate change’s effects whilst the world’s poorest will have their right to housing, food, life, safety and, as I outlined here, health, threatened. When it comes to human rights, and particularly the gains we have made in health and the precariousness of these gains, it is imperative that we keep them at the heart of our climate policy and the societal debates we are having on what best to do to tackle the climate crisis. Health, whether physical or mental, communicable or non-communicable, is a fundamental human right that is under pressure in a changing world. The potential repercussions of that are dire if our policymakers and health systems do not adapt to these realities quickly. Conversations surrounding ambitious policy proposals like the Green New Deal ought to centre human rights in general, however the right to health should not be underestimated or kept on the back burner. At the end of the day, vulnerable, poor, and indigenous communities will bear the brunt of our complacency, and we cannot afford to let that happen.

Indigenous rights and the climate emergency

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“The lungs of our planet are on fire” was a common refrain heard in the past days as a response to the unprecedented wildfires in the Brazilian Amazon. An international outcry from politicians, celebrities, and regular people on the internet alike, was urgent and panicked: we need to do something now or we’ll lose the forests, we’ll release high levels of carbon stored in the rainforest’s trees into the atmosphere, and we’ll lose the Amazon’s immense biodiversity. However, the focus on the inhabitants of their ancestral lands, however fleeting, came much later, even though they have been raising concerns about the Brazilian government’s rhetoric and its encouraging of illegal exploitation of indigenous land for a long time.

A couple of days before the Amazon wildfires reached global headlines, Brazilian indigenous women marched against Bolsonaro’s government. This was just one instance of the Amazon rainforest’s indigenous tribes – and in particular its women – fighting to preserve their ancestral land even when we aren’t paying attention.

Environmentalism has regained its fashionability as our winters feel like summers and our summers become infernal, and young voices are getting more earnest about what climate catastrophe would mean for them and the next generations to inhabit the planet. However, it seems like the movement has its internal issues it ought to, but doesn’t nearly as much as it should, contend with. One of the main issues with the movement was showcased when the emphasis was placed on the Amazon being the ‘lungs of our planet’ without mention of the many people who have lived there for generations and the systematic destruction of their homes, livelihood and land at the hands of governments and Western consumer behaviour. When the plight of indigenous tribes across the world are mentioned, it’s often from a Western perspective with an insidious sense of paternalism rather than highlighting the voices of the people on the front lines. The United Nations itself has said that indigenous peoples play an important role in tackling climate change. But it goes beyond just including, or even centring, indigenous voices in the climate debates. When indigenous people, in particular women, are still disenfranchised, abused, incarcerated, have trouble accessing a basic human right like healthcare and still fight for a say in how their sacred land is used, it is imperative that we do not just see indigenous peoples as resources to be used to fight the climate emergency, but as communities that are vulnerable to climate change’s effects and many social injustices. It is clear that if we are going to be serious about environmentalism, that we will have to centre indigenous voices and fight for the (human) rights of indigenous peoples.

In the Congo, Baka people have been pleading with WWF and the European Commission to stop funding a national park that threatens their way of life. Sadly, this is hardly a unique situation when it comes to indigenous people’s rights and livelihoods in the conservation industry. Human rights abuses seem to be commonplace in conservation, with a recent scandal haunting the world’s most recognisable conservation NGO the WWF. Local poor and indigenous people are being murdered, raped, attacked and shunned, all in the name of conservation. The narrative we have constructed says, sometimes implicitly and sometimes not, that we care about indigenous land and its biodiversity, but not about indigenous peoples. Simultaneously, we seem to place the blame of climate destruction squarely on the shoulders of the poor and indigenous rather than face our own patterns and unsustainable economic systems in the metaphorical mirror.

The narrative we have constructed says, sometimes implicitly and sometimes not, that we care about indigenous land and its biodiversity, but not about indigenous peoples

To have environmentalism, conservation, and climate change activism mean something, we will have to centre human rights and indigenous voices. Climate activism without social and economic justice and respecting human rights is nothing but a self-congratulatory movement that does more harm than good. Caring about, and centring, indigenous voices means taking a step back and listening when necessary as well as amplifying and lobbying on tribes’ behalf when asked.

Whether it is indigenous tribes in the Brazilian Amazon, or Baka people in the Congo, the rights of people living on, and in sync with, their ancestral land should be respected and should be front and centre in the climate debates. For our activism, lobbying, policies and worries to mean anything we need to listen and act when required. What use are lungs without the peoples that make up the body?

(consider donating to Amazon Watch, Survival International and the indigenous women’s march in Brazil.  Also consider writing your MP/MEP and sharing indigenous voices on social media)

Healthcare as a human right.

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Any discussion of universal healthcare is seemingly conducted as if it is a solely partisan issue. The left wants universal healthcare, the right doesn’t — so goes the argument. However, the fact of the matter is that the United Nations’ Universal Declaration of Human rights, article 25, states that:

(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

The countries that have signed up to this declaration have implicitly or explicitly accepted healthcare as a human right. Most countries provide free or affordable healthcare to its citizens, but how it manifests for non-citizens seems to differ between countries. We can do better.

War and natural disasters seem common and omnipresent, and will likely increase with climate change. Unsurprisingly, these calamitous events will also leave the most vulnerable exposed to health risks — particularly women, children, the elderly, and the chronically ill. Particularly in war and conflict areas, getting healthcare to the most vulnerable populations can be an arduous task, made more difficult by various state actors and disparate political motivations. Attacks on humanitarian aid workers make it difficult for vital medical care to arrive to the people who need it most. The World Health Organisation’s (WHO) 2017 report estimates that 14.8 million people in Yemen have no access to healthcare, and the International Medical Corps has said that delivering healthcare to affected populations in the country is difficult with major infrastructure destroyed, and the lack of a government that could support them. In addition, Amnesty International reports that the Saudi-led coalition has restricted the access to essential goods such as medical supplies from entering Yemen. The situation in Syria is equally dire, with the WHO reporting calamitous conditions in Syrian refugee camps, and additionally refugee camps housing former members of ISIS and their children have also not received adequate medical assistance. Chatham House experts recently wrote that many people with chronic illnesses end up being under-treated in war and conflict as the nature of chronic illnesses and the nature of war make it logistically very difficult to help them. In many instances, these local makeshift hospitals end up being in rebel-held territories with Western aid organisations fearing a loss of funds if they were to support these hospitals. From a security and counterterrorism point of view this might make sense, but the fact of the matter is that vulnerable people will see their right to medical assistance denied. It is clear that healthcare as a right is often a casualty of war, with deliberate attacks on hospitals, as well as restrictions on humanitarian aid depending on whose side the territory is held by, creating more issues for the local population and constituting continuous violations of international humanitarian law and human rights.

Closer to home, it is often the case that refugees and immigrants do not get to enjoy free healthcare in the same way citizens of a country can. A report by the Equality and Human Rights Commission published in 2018, showed that asylum seekers in Britain are often afraid of seeking medical care for fear of high costs, or being tracked by the Home Office. Ambiguities and an increasingly hostile environment for migrants, refugees, and asylum seekers, create inaccessibility to healthcare for an already vulnerable group of people. Guaranteeing that everybody, regardless of background and citizenship status, gets access to healthcare that respects human rights, requires political will and leadership. Moreover, people with mental health issues are still often subject to violations of human rights in mental health care where they are often stripped of agency and dignity — this has been the observation of the UK’s parliamentary and health service ombudsman as well. In the United States, many black women are dying in childbirth because they are not listened to in health settings and their human rights are systematically violated. Worldwide, people with dementia are still fighting for their human rights to be respected. There is still a lot to be done.

So, how do we make sure that human rights are respected and guaranteed, even in disaster and conflict zones, even when someone is an asylum seeker or a refugee, and even when the patient is disabled, mentally ill or cognitively impaired? There is no simple answer, but political leadership that sees beyond manoeuvring and posturing to behold the human cost of war, conflicts, health disparities locally and globally, and the victims it makes, would go a long way. In an international setting the countries with vetos in the UN security council have a particular responsibility to look beyond political expediency and geopolitics when the stakes are so high and there are no winners. The WHO has a prime position as an intergovernmental organisation to coordinate medical response and epidemiological research, and assist local governments after a disaster or in conflict zones. Human rights organisations monitoring, researching, and advocating for human rights to be respected, in conflict and in peacetime, play a vital part in holding the powers that be to account. Academic research in how to best coordinate humanitarian aid, particularly medical aid, in disaster and conflict zones is imperative. Non-governmental aid organisations and their local partners on the ground need continued support to take care of affected citizens regardless of their affiliations in war. Disability and mental health advocates need to be listened to. And finally, as citizens we have a duty to be aware and cognisant of our human rights, the inalienability of it, and that by respecting them we are doing not only the other, but our selves, a great service. By being informed and educated on the role human rights play in our day to day lives, we can lobby and advocate our local governments, and in turn politicians of good will can effect change. Eleanor Roosevelt, the mother of the UN Declaration of Human Rights, said it best:

Where, after all, do universal human rights begin? In small places, close to home – so close and so small that they cannot be seen on any maps of the world. Yet they are the world of the individual person; the neighbourhood he lives in; the school or college he attends; the factory, farm, or office where he works. Such are the places where every man, woman, and child seeks equal justice, equal opportunity, equal dignity without discrimination. Unless these rights have meaning there, they have little meaning anywhere. Without concerted citizen action to uphold them close to home, we shall look in vain for progress in the larger world.

Period.

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Most, if not all, women and girls have at one point carried their entire bag to the toilet to hide the fact that they’re on their periods. Perhaps, they’d slip their pads or tampons into their sleeves so as not to offend or alert the people around them of the fact that their bodies are experiencing a perfectly normal (albeit not strictly necessary) monthly biological process. Periods are still stigmatised. Period poverty is a term that has gained some traction in recent years, particularly in Scotland where the Scottish government has put into place ways to eradicate it. Period poverty refers to women and girls being unable to afford sanitary products, which in turn causes women to turn to toilet rolls, rags and cloths instead.  Indeed, period poverty is even keeping girls out of school! This is why the Scottish government pledged to provide free sanitary products in every school, college and university, and in England there are movements to provide the same for girls there.

Further afield, period poverty and stigma are, unsurprisingly, also an issue. Not unlike women and girls in the UK who cannot afford sanitary products, women in many low- and middle income countries (LMIC) also resort to using rags, cloths, and in some cases animal skin or leaves to absorb menstrual blood. In many cases women and girls also lack safe and private (single sex) bathrooms and toilets, clean and running water, and soap to keep themselves clean and comfortable during their menstrual cycle. This often leads to girls dropping out of school, and women not working. Periods are not a very glamorous issue to talk about (not unlike many other issues that affect mainly women), but it is definitely a global health issue.

Discussing periods is often taboo in many LMIC where women on their periods are seen as ‘unclean’, and at times even shunned for the duration of their periods where they have to stay in unsanitary, cold and unsafe menstrual huts, where many women and children often end up dying. In many instances women and girls hold misconceptions and fears surrounding menarche (first period) and subsequent periods, with many harbouring fear of infertility or curses (and Sommer et al., 2014). A lack of access to proper hygiene during the menstrual cycle can lead to a higher risk of infections, and bodily odours can lead to further stigmatisation. Menarche can also have a mental health effect on girls, who often feel anxious and sad about a ‘loss of childhood’ once they have experienced their first period. Thus, beyond the physical issues that a lack of access to sanitary products, hygienic toilets and sanitation, and the risk of infection that comes with it, the stigmatisation of periods and the cultural associations, taboos and silence surrounding it can have a detrimental effect on mental health as well.

That is not to say that all hope is lost. Just like the community activists in the United Kingdom, there are many women in LMIC who are fighting to make menstruation and women’s health more accessible and acceptable to talk about and are fighting to end period poverty all around the world. NGOs such as Myna Mahila, which gained some more international recognition after the Duchess of Sussex’s involvement, and organisations such as Plan and the UN are also trying to play their part. Not unlike tackling the stigma of dementia in LMIC, it is important for us to understand the cultural contexts and aid local community activists where possible.

In Western feminism we talk an awful lot about ’empowerment’, but sometimes seem to forget that at the end of the battle for empowerment there is supposed to be power. For women to gain more power and influence in a truly more equitable society, it is imperative that women can get an education, take charge of their own lives and most importantly do not feel like prisoners in their own bodies. We have long known that once women are more educated, there is a decline in poverty, and once women are financially independent there is a decline in vulnerability to sex based violence. If we truly believe in empowerment for women, we will need to fight to remove the taboos and stigma surrounding menstruation and eliminate period poverty whether it occurs in Scotland or in India, the United States or Uganda. It’s not just a women’s rights issue — it’s a human rights and a global health issue. An issue that should, and hopefully will, be eliminated once and for all.

Dementia, global health, and policy.

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When we think of dementia we often think of the elderly, probably in care homes, possibly our own family. Most of our visions are of dementia’s manifestation in high income countries. The truth of the matter is, that an estimated 58% of people with dementia live in low- and middle-income countries (LMIC) . To add insult to injury, it was estimated that only 10% of the research into dementia is focused on people living with it in LMIC (Prince et al., 2008).

Many people in LMIC will go undiagnosed, as people often see dementia as a normal part of ageing and those suffering are often stigmatised. Seeing dementia as a normal part of ageing is in and of itself not limited to LMIC, as many people in high income countries at the very least seem to think it is a kind of inevitability. Moreover, stigma certainly also still exists in the West. Many people who are diagnosed indicate that they feel isolated, that their lives are over, that people stop treating them as fully human, and in extreme cases in certain parts of the world elderly people — primarily women — with dementia are accused of witchcraft and ostracised, and in the worst cases, even killed. 

Because dementia is a disorder that will affect more and more people as populations, on average, get older and older, it is often seen by organisations such as the World Health Organisation (WHO) and Alzheimer’s Disease International as a global health priority. Global health is a relatively new concept, with a relatively vague definition, but is generally taken to mean the promotion of equality when it comes to access and quality of healthcare worldwide. Global mental health, has a similar remit only focused on the psyche rather than (just) the physical body. Although these ideals are lofty, and the UN declared health care a human right (article 25 of the UN Declaration of Human Rights — I suggest you give the whole thing a read), there is always the looming possibility of Westerners imposing their own view on others; some would even go as far as to say it is a form of neocolonialism. That does not, however, mean that I think we should throw out the baby with the bathwater. Global (mental) health can be directed by the people of the Global South with the Global North and its institutions (such as the UN) aiding and advocating on their behalf. This means employing, and listening to, locals who will take the cultural sensitivities into account (examples include Chief Kiki Laniyonu Edwards who works to tackle stigma of dementia in Nigeria; Zimbabwean grandmothers offering therapy, Benoit Ruratotoye, a Congolese psychologist trying to tackle violence against women and particularly help the spouses of women raped as a weapon of war to come to terms with what happened, or Women for Afghan Women) . It means adjusting our diagnostic manuals and criteria so that they are relevant and valid within the country’s specific cultural context. It is working together with the spirit of true equality, seeing the people in LMIC/Global South not as people we need to convert, but people we can work with for the benefit of us all.

Returning to the lack of basic research on dementia and its manifestations in LMIC, I think it is important as scientists to be aware of our own biases and our tendency to extrapolate and apply our Western experience to that of everybody else. It is important for researchers in LMIC to have the funds and means to conduct studies on the manifestation of not only dementia, but mental health issues, in their own people and in their own cultures. It is vital that Western universities collaborate, not as superiors but as true and equal partners with the desire to bring about equality in access and quality of healthcare.

I am of the belief that basic scientists, local experts, global health professionals and policymakers would be best served in working together. Issues such as dementia and depression have different cultural manifestation in different cultural contexts. It is vital that policy is made on the basis of scientific knowledge, local knowledge, cultural sensitivity and a genuine belief in promoting equality of access and quality of healthcare. Perhaps the UN as an institution, and definitely its human rights declaration, is too optimistic or idealistic in a world full of violent realities. But it is most certainly the kind of hope and optimism we need on this blue planet we all share. Combining our knowledge (both Western and non-Western, scientific and traditional), using our privileges for good, and looking beyond our own bubble without superiority is the only way we can get closer and closer to the lofty dreams and aspirations of a truly equitable world where human rights, including the right to healthcare, are respected.