CUGH satellites: Mental health, climate change, equitable collaboration
May/June 2023 | Volume 22 Number 3
Credit: Health Caribbean CoalitionAd campaign from the Healthy Caribbean Coalition
By Susan Scutti
The many traditions of the annual Consortium of Universities for Global Health (CUGH) conference include presenting a rich array of virtual satellite sessions to the public. This year’s agenda encompassed examinations of machine intelligence, road traffic crashes, rising mistrust of public health, cancer research, crisis preparedness, and blindness. Two sessions of note focused on mental health as a noncommunicable disease (NCD) in the context of Caribbean and the way universities can support equity in global health collaborations.
Post-colonial mental health
Though similar in many ways, the 26 islands of the Caribbean diverge in terms of resources; the World Bank classifies Antigua’s economy as high-income, Jamaica’s as upper middle-income, and Haiti’s as lower middle-income. Recent changes, including the COVID-19 pandemic, decriminalization of marijuana, and climate change-related weather events, have fueled a rise in mental health issues across the region. This wellness deficit, which encompasses neurological and substance use disorders, often worsens the outcomes of other NCDs, such as diabetes and cardiovascular disease, warranting urgent attention.
Caribbean researchers addressed these interlinked issues in a session, “Mental Health: A solution for reducing NCDs in the Caribbean,” organized by the American University of Antigua College of Medicine. Their central theme was the rising burden of NCDs (including mental health disorders) faced by the region. Presenters emphasized the necessity of recognizing trauma as a driver of NCDs along with understanding how alcohol, tobacco and cannabis contribute to preventable chronic disease and disability.
Caribbean youth want to destigmatize mental illness and its treatments. Meanwhile, researchers find that community-based interventions—when aligned with the actions of society as a whole—are the best hope for tackling mental health disorders, even though implementation of shared strategies can be costly.
Climate change and reef ecosystems
Medical student Leo Santiago examined how climate change has distressed Caribbean ecosystems, including coral reefs. While each island has high vulnerability to global warming, Haiti is most vulnerable, he noted. Sargassum, a type of brown macroalgae, has exploded across the region as a result of changing temperatures. While the algae can provide a habitat and food for fish, large blooms can block sunlight, killing seagrass which results in less oxygen in the water and leads to the death of fish. Another change in the region is the arrival of an invasive species, lionfish, native to the Indo-Pacific. This predatory breed harms reef ecosystems when it out-competes overfished native stocks, such as snapper and grouper, for food and space, said Santiago.
Capacity
exchange
Seeking to identify administrative and policy changes that would support equity in global health research collaborations, Harvard Medical School organized the satellite session, “Transforming Universities for Equity and Impact in Global Health.” Moderated by Dr. Kathryn Chu of Stellenbosch University, a rousing panel discussion spilled over into the chat and led to a collective reckoning around the concept of equitable collaboration.
Dr. Dana Thomson of Harvard Medical School questioned the term "capacity building," noting that it is often assumed to mean a transfer of knowledge from high-resource to lower-resource nations. “This reinforces an inequitable narrative,” she said and suggested "capacity exchange" as a more accurate descriptor of global health partnerships. Dr. Rashi Jhunjhunwala, also at Harvard Medical School, described how the medical students and surgeons in Rwanda taught her “realities on the ground” and innovations unknown in the U.S. “If I worked in a rural area in the U.S., I could use these methods. Who has benefitted ‘more’ from these partnerships? I have learned flexibility, creativity, workshopped context-related challenges, and grown as both a surgeon and researcher,” she said.
University of Nairobi’s Dr. Manasi Kumar commented, “De-colonialism is not just a dialog between high-income and low-income countries, but also between hierarchical levels within institutions.” She suggested middle income nations have the most nuanced understanding of the dynamics of “uneven” exchanges, given their middle child status. Equitable research partnerships require adoption of new, alternative visions, and revision of institutional structures, noted Kumar.
Dr. Wendy O’Meara, Duke University, said publication guidelines for authorship disrupt the potential for equity. “Research does not just begin at analysis,” she noted, adding that a great deal of the work that happens before the rigorous data analysis—work done by “middle” authors—is undervalued. “I see positive change when partners on both side of the cooperation come together and are willing to be transparent about what they want … and then agree how the partnership needs to change or work,” she said.
Equality of funding
Vanderbilt University’s Dr. Quentin Eichbaum would like to see the cake divided more equitably. He identified an issue that frequently troubles global health partnerships: many high income country collaborators choose to work at only the big name LMIC institutions—University of Global Health Equity in Rwanda, Makerere University in Uganda, and various South African universities, for example—rather than at lesser-known institutions that might benefit more from partnerships. “There are about 130 new medical schools in Africa at various stages of development… but NIH/CDC/Fogarty have consistently been risk-averse and preferred to develop partnerships at and fund well-established institutions.”
Stanford’s Dr. Michele Barry suggested advocating for increased allocation of grant funds for indirect costs to the Global South while also twinning, or pairing, well-funded partner institutions with less well-known institutions whenever a research grant is awarded. Eichbaum agreed that twinning could help, but added that sharing funds among the institutions (and not just offering “advice”) would be crucial for these strategies to work.
Summarizing the session, University of Pittsburgh’s Dr. Maureen Lichtveld, a Fogarty board member, shared that, as a member of promotions committees and a peer reviewer, she, herself, has valued or devalued other researchers along hierarchical lines—downgrading the comments of academics based in LMICs (or in lesser-known universities in high income countries) and failing to give proper due to authorship that is neither first nor last. “I’ve been on those committees, so I know that we are the ones who don’t value certain experiences,” she said.
More information
Updated June 15, 2023
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