Cancer linguistics and the politics of decolonizing health communication in Coastal Tanzania: Reflections from an anthropological investigation.

The role of language in maintaining asymmetries of power in global public health and biomedicine has become a central part of the broader movement to "decolonize Global Health." While considering how language engenders inequalities in Global Health, hinders interventions, and inhibits medical care, this article contends that colonially derived theorizations of what language is undergirding top-down health communication efforts labeled as "decolonial" can thwart efforts to make biomedical care and public health clearer in postcolonies. We do this through outlining predicaments found in a linguistic anthropological exploration of cancer terminology in Coastal Tanzania. In the small town of Bagamoyo, saratani-the official translation for cancer in Tanzania created by the government in the 1980s as part of a larger effort of decolonial state-building-is dominantly understood as a different or unequivocal disease than kansa-the English-adapted name. As the dissemination of the term saratani into a linguistic arena where colonially derived word kansa is dominantly registered as the biological disease "cancer," this linguistic disjuncture between saratani and kansa has not only created a plethora of problems for oncological care in Bagamoyo, but also illuminates the perils of creating more just health communication in an unequal global political economy. Through showing how binary conceptualizations of language as "colonial" and "local" can reproduce incommunicability-the rendering of racialized subjects as fundamentally unintelligible in hegemonic regimes-we contend that the afterlives of this past effort to decolonize medical language has important lessons for the present of "decolonizing Global Health." Moving beyond static conceptualizations of language, we argue for a fluid "translanguaging" perspective of medical linguistics that facilitates the dismantlement of incommunicability and the global ordering that creates it.

Kansa talk: mapping cancer terminologies in Bagamoyo, Tanzania towards dignity-based practice.

This paper reports and examines the results of qualitative research on the use of local cancer terminology in urban Bagamoyo, Tanzania. Following recent calls to unify evidence and dignity-based practices in global health, this research locates local medical sociolinguistics as a key place of entry into creating epistemologically autonomous public health practices. We used semistructured ethnographic interviews to reveal both the contextual and broader patterns related to use of local cancer terminologies among residents of Dunda Ward in urban Bagamoyo. Our findings suggest that people in Bagamoyo employ diverse terms to describe and make meanings about cancer that do not neatly fit with biomedical paradigms. This research not only opens further investigation about how ordinary people speak and make sense of the emerging cancer epidemic in places like Tanzania, but also is a window into otherwise conceptualisations of 'intervention' onto people in formerly colonised regions to improve a health situation. We argue that adapting biomedical concepts into local sociolinguistic and knowledge structures is an essential task in creating dignity-based, evidence-informed practices in global health.

Global health and the elite capture of decolonization: On reformism and the possibilities of alternate paths.

Global Health is experiencing a moment of reckoning over the field's legacy and current structuring in a world facing multiple, intersecting challenges to health. While "decolonization" has emerged as the dominant frame to imagine change in the field, what the concept refers to and entails has become increasingly unclear. Despite warnings, the concept is now being used by elite Global North institutions and organization to imagine their reformation. In this article, I attempt to provide clarity to the issue of conceptualizing change in Global Health. By first outlining a brief history of decolonial thought and then exploring the current state of the decolonizing global health literature, I show a profound disjuncture between popularized calls for decolonization in Global Health and other theorizations of the term. I then argue that the diluting of "decolonization" into a depoliticized vision of reforming the inherently colonial and capitalistic institutions and organizations of Global Health is an example of "elite capture"-the coopting and reconfiguration of radical, liberatory theories and concepts then used by elites for their own gain. Showing how this elite capture has facilitated harm within the field and beyond, I conclude by calling for resistance to elite capture in all its forms.

Transforming global health education during the COVID-19 era: perspectives from a transnational collective of global health students and recent graduates.

Inspired by the 2021 BMJ Global Health Editorial by Atkins et al on global health (GH) teaching during the COVID-19 pandemic, a group of GH students and recent graduates from around the world convened to discuss our experiences in GH education during multiple global crises. Through weekly meetings over the course of several months, we reflected on the impact the COVID-19 pandemic and broader systemic inequities and injustices in GH education and practice have had on us over the past 2 years. Despite our geographical and disciplinary diversity, our collective experience suggests that while the pandemic provided an opportunity for changing GH education, that opportunity was not seized by most of our institutions. In light of the mounting health crises that loom over our generation, emerging GH professionals have a unique role in critiquing, deconstructing and reconstructing GH education to better address the needs of our time. By using our experiences learning GH during the pandemic as an entry point, and by using this collective as an incubator for dialogue and re-imagination, we offer our insights outlining successes and barriers we have faced with GH and its education and training. Furthermore, we identify autonomous collectives as a potential viable alternative to encourage pluriversality of knowledge and action systems and to move beyond Western universalism that frames most of traditional academia.

30 years of polio campaigns in Ethiopia, India and Nigeria: the impacts of campaign design on vaccine hesitancy and health worker motivation.

INTRODUCTION: The debate over the impact of vertical programmes, including mass vaccination, on health systems is long-standing and often polarised. Studies have assessed the effects of a given vertical health programme on a health system separately from the goals of the vertical programme itself. Further, these health system effects are often categorised as either positive or negative. Yet health systems are in fact complex, dynamic and tightly linked. Relationships between elements of the system determine programme and system-level outcomes over time. METHODS: We constructed a causal loop diagram of the interactions between mass polio vaccination campaigns and government health systems in Ethiopia, India and Nigeria, working inductively from two qualitative datasets. The first dataset was 175 interviews conducted with policymakers, officials and frontline staff in these countries in 2011-2012. The second was 101 interviews conducted with similar groups in 2019, focusing on lessons learnt from polio eradication. RESULTS: Pursuing high coverage in polio campaigns, without considering the dynamic impacts of campaigns on health systems, cost campaign coverage gains over time in weaker health systems with many campaigns. Over time, the systems effects of frequent campaigns, delivered through parallel structures, led to a loss of frontline worker motivation, and an increase in vaccine hesitancy in recipient populations. Co-delivery of interventions helped to mitigate these negative effects. In stronger health systems with fewer campaigns, these issues did not arise. CONCLUSION: It benefits vertical programmes to reduce the construction of parallel systems and pursue co-delivery of interventions where possible, and to consider the workflow of frontline staff. Ultimately, for health campaign designs to be effective, they must make sense for those delivering and receiving campaign interventions, and must take into account the complex, adaptive nature of the health systems in which they operate. .