Global health is a field rooted in colonialism and inequality. Every part of the effort to address global health today is dominated by individuals and institutions in high-income countries. This includes funding, authorship of publications, leadership of organizations, composition of boards, editorial positions, and participation in conferences. It is a field where people from, or working in, the Global North, still by and large determine the interventions and priorities of the Global South.
A new awareness of these power asymmetries has resulted in calls to “decolonize” the field, making it more equitable. Because of its reach beyond the academic and scientific world, journalism is in a unique position to challenge dominant narratives and help demolish stereotypes. But in order to do so, journalists focused on global health need to be mindful and reflexive.
Using Twitter to crowdsource, we identified some of the best, most important practices for journalists. We know resources and time are often scarce, and perhaps not all of these recommendations can be followed explicitly for every story, but we hope awareness of better practices can help guide reporters toward a body of work that is overall more inclusive, fair, and equitable.
Try not to quote exclusively, or even predominantly, experts in the Global North. This amplifies the perspectives of those who already hold much of the power and privilege in the field. If you are looking for sources in organizations based in the Global North, consider the voices of experts who aren’t only from western countries.
Black, Indigenous, and people of color (BIPOC), as well as women and nonbinary voices are often forgotten in stories about global health. Seek them out. Before publishing your story, count the people quoted and note the gender, racial, and geographical balance.
Center the people you are writing about. If your story is about programs or problems in low- and middle-income countries, the sources in your story should reflect that. If you are writing about Ebola in Uganda, for example, then make the story primarily about Ugandan people, communities suffering from Ebola, and national and regional experts fighting the outbreak.
International organizations involved in programs in the Global South will often offer officials in their headquarters as the first, and most accessible, sources. Ask instead to talk to people working on the ground, even better if they are local, and working for local organizations.
Speak with those who have experienced the issue you are writing about. An article about HIV or polio should include the voices of people living with HIV or polio.
Go beyond big-name experts and include frontline healthcare workers (like nurses or community health staff) and regular people. The higher-ups can sometimes be ignorant of on-the-ground realities.
Covering crises in low-income nations purely with statistics and numbers can often dehumanize the people who are most impacted. It reduces them to disease carriers and victims, depriving them of the agency, empathy and dignity they deserve. Numbers alone can be numbing, and make tragedies abstract and distant.
If you aren’t in a position to add individual stories to your reporting, introduce context and comparison to help readers understand the impact of the issues in terms with which they are more familiar.
Question your assumptions and beware of the places where prejudice might sneak in, like your choice of adjectives, in the details you decide to highlight, in how you frame stories.
Always highlight the global repercussions of every local crisis, and the interconnectedness of all people. Avoid hysteria based on otherness and understand that incremental progress can have tremendous impact. At the same time, don’t assume populations of low- and middle-income countries accept lower health and life standards than those living elsewhere.
Stigmatizing names or nicknames (i.e. Chinese flu, monkeypox, African virus) are also othering and can be used to target communities. Raise concerns when you encounter them.
The jargon of global health and development can be off-putting for writers, let alone readers. It is a cacophony of acronyms and composite labels, and simplification is sometimes necessary. There are, however, terms that are obsolete, simplistic, or even racist, and while they might read better from a copy perspective, can end up obfuscating more than they clarify. The list evolves as we all learn and understand more, but it is best to avoid terms like “Third World countries,” “poor countries,” and “developing countries.” For better alternatives, you can refer to this resource.
Make sure you adequately credit scientists and experts in low- and middle-income countries. Remember the famous case of Jean-Jacques Muyembe, the Congolese doctor who discovered Ebola, but for decades never got credit.
Look for previous reporting on the topic, and always cite local journalists and publications whose coverage has informed your work.
When you collaborate directly with local journalists, note the collaboration in your stories. Co-author articles with them, when possible. A so-called “fixer” is often essential to your story and should be credited. Don’t deny your colleagues the recognition they deserve.
Check, and if relevant, describe the conflicts of interests of those interviewed and quoted. Be transparent about your own conflicts, for instance by disclosing who is funding your reporting.
There have been many examples of racist cartoons and caricatures during the covid-19 pandemic. Reject the use of imagery that discriminates, stigmatizes, and incites hate.
In photos and captions, list the names and affiliations of all people depicted, not just the ones from the Global North or with advanced titles.
Research shows that many global health stories depict women and children from low-income and middle-income countries with less dignity, respect, and power than those from high-income countries. Make sure pictures, especially taken in times of crisis, respect people’s dignity. If you wouldn’t feel okay seeing yourself or a loved one depicted in the same way, you should probably not use that image.
Try to move beyond the high-income, English-speaking bubble. In many contexts, speaking English is, in itself, a privilege most don’t have. Talking to people who don’t hold advanced degrees from western or English-speaking institutions is often a great way to find underreported stories.
Don’t assume that the ways of doing things in high-income countries are better than the ways of doing things in lower-income countries. In many cases, the opposite is true. Showcase the lessons, solutions, innovations and progress coming from areas of the world where the stories originate, and not just the challenges affecting them.
Be careful about sweeping, simplistic stories. The reality is often complex, and careful framing is important. Take for instance this story: “Poorer nations dump millions of close-to-expiry Covid-19 vaccines.” This is technically true, but the reason is that they received them too close to their expiration date from rich donor countries. The main issue here is that rich nations hoarded vaccines until it was too late.
Editors: You have a lot of power in shaping the narrative. Here are a few ways in which you can exercise it:
- Hold your reporters accountable to these guidelines, and help them shape their reporting and stories accordingly.
- Commission stories directly from journalists in the Global South (with fair pay), especially those closest to the problems, rather than parachuting in foreign correspondents.
- Ensure that headlines reflect the core of the stories, and are not sensational, misleading, or clickbait.
- Insist on including voices of people with lived experience, women, BIPOC, and experts in the Global South.
- Decline cartoons and op-eds that are racist, stigmatizing, or approach the issues of global health without awareness of the unequal powers at play.
- Seek out op-ed pitches from BIPOC, women, and Global South authors.
Journalists can learn a lot from ongoing discussions about decolonizing global health, and adopt an approach that considers the power imbalance so pervasive in the field. Global health journalism will become equitable only when journalists and editors adopt a more critical and truly global perspective, centering their reporting on those with the most lived experience.
Acknowledgements: We are grateful to everyone who commented on the Twitter thread and offered valuable suggestions. We welcome feedback, which we will continue to use to inform our work.
Madhukar Pai is a professor and Canada Research Chair of Epidemiology & Global Health at McGill University in Montreal. He is editor in chief of PLOS Global Public Health, and a regular contributor for Forbes. He has no financial or industry conflicts. He serves as an advisor to several non-profit organizations in global health, including WHO, Stop TB Partnership, FIND, and Bill & Melinda Gates Foundation. None of these groups were engaged in this article.
Annalisa Merelli is a senior reporter at Quartz, covering the intersection of health and inequality.