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What roles do power, politics and privilege play in public health? 

That’s one of the questions participants can explore at the University of Toronto’s upcoming Global Health Summit, , organized by the from November 3 to 5.  

Writer Elaine Smith asked each of the four ÀÏ˾»úÖ±²¥ experts behind the conference’s Power, Politics and Privilege theme the same question: what is the most important way in which power, privilege and politics determine health equity?

Stephanie Nixon, associate professor at the Dalla Lana School of Public Health and in the at the :

It is well-accepted that people with certain experiences of disadvantage (e.g., lower income, race) have worse health, but what our fields are often silent on is how advantage and privilege lead to better health.

We need to be more insightful about the role privilege plays in shaping global health equity, and also how it shapes our own programs of research. Such insights can lead to greater humility about how certain we are in our ‘expertise’.

It’s not that our work is wrong; I’m proposing there is a blind spot. It can be hard to get one’s head around the idea of privilege when you are in a position of advantage, and it can be very unsettling because it means that your successes might not be solely based on your own hard work. There are big, important, health-defining social structures that you see when you look at things through the lens of privilege.

Nurturing this understanding will help us all to do more socially just work.

Jillian Clare Kohler, director of the collaborative doctoral program in global health at the Dalla Lana School of Public Health and associate professor and director of global health at the and the :

I am exploring how corruption affects health outcomes and what anti-corruption tools are most effective at ensuring that we get health products and services to people in need. 

Abuse of power can allow for corruption and we are increasingly being presented with evidence that demonstrates how corruption can kill. We only need to think about and falsified medicines to bring this point home.

Now, there is at least acknowledgement that corruption is a global health issue. We need to consider how to develop institutional mechanisms where we can control bad behavior and reduce the likelihood of corruption from happening. If we have the right institutions in place, we can at least make some serious efforts to curb it.

Improving access to health care means ensuring corruption does not happen. We need to bring corruption and bad behaviour out into the open and make it more transparent.

Lisa Forman, assistant professor at the Dalla Lana School of Public Health and director of the comparative program on health and society at the : 

Lack of power seems to equate, in many respects, to a lack of health care or to poorer health outcomes. Sometimes, poor health and health-related policy is a result of benign policy neglect, but it may also result from social and policy-level stigma and bias. In both cases, a human rights framework can be used to challenge neglectful or discriminatory policies. 

For example, individuals and groups around the world have used human rights frameworks to launch successful legal challenges against government health policies and programs that unfairly exclude already marginalized populations such as sex workers, people with HIV and AIDS, lesbian, gay, bisexual, transgendered and intersex people, and people with disabilities.

Human rights scholars promote the human right to health which says that we all have the entitlement to access adequate health care and to be healthy. Interestingly, it’s easier to make these arguments in places like China and Peru than it is in North America. Here, human rights work is very much limited to civil and political rights. People see talking about the right to health as socialist or communist. Yet the human rights framework is increasingly recognized as key to addressing health inequities.

Jennifer Gibson, associate professor at the I and director of the :

I’m eager to discuss what the potential ways are to empower people to shape political structures and societies that enable health. Power structures in society can create barriers, but if there is civic engagement, we can think about reallocating the power to those most affected [by inequitable access to health resources].

We need to work with patients and populations to create the material conditions that improve health equity. We have a moral obligation to listen to those voices and be sure their perspectives can be brought into play. It must be intentional, not just window-dressing.

We want people to be able to say, ‘Not only do I have the benefits of access to health resources, but I helped create the conditions to make them possible.’ Sustainable change comes when the people who are affected by the change take part in creating it.

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