建立全球急诊医学非殖民化框架

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES AEM Education and Training Pub Date : 2024-05-16 DOI:10.1002/aet2.10982

Monalisa Muchatuta MD MS, Shama Patel MD, MPH, Catalina Gonzalez Marquez MD, MPH, Kaushila Thilakasiri MBBS, MD, MRCEM, Sreenidhi Vanyaa Manian MBBS, Jennifer Chan MD, MPH, Ngassa Mssika DO, Taryn Clark MD, Taylor Burkholder MD, MPH, Nikkole Turgeon MD, Vinay N. Kampalath MD, DTM&H, Nivedita Poola MD, O. Agatha Offorjebe MD, Adeline Dozois MD, Gimbo Hyuha MD, Oluwarotimi Vaughan-Ogunlusi MD, Carol McCammon MD, Katie Wells MD, MPH, Megan Rybarczk MD, MPH, Maria Paula Castillo MD, Adebisi Anthonia Adeyeye MBBS, Chris A. Rees MD, MPH, Sanjukta Dutta MBBS, Stephanie Chow Garbern MD, MPH, DTM&H

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引用次数: 0

摘要

背景全球急诊医学（GEM）位于全球健康和急诊医学（EM）的交汇处，而全球健康和急诊医学建立在殖民制度和机构的历史基础之上，这些制度和机构今天仍在加剧高收入国家（HICs）和中低收入国家（LMICs）之间的不平等。这些权力不平衡造成了全球急救医学在实践、研究和教育方面的差异。方法 2020 年，急诊医学学术学会（Society for Academic Emergency Medicine）下属的全球急诊医学学会（Global Emergency Medicine Academy，GEMA）成立了全球急诊医学非殖民化工作组（Decolonizing GEM Working Group），目前全球已有 100 多名成员。工作组的任务是解决 GEM 中的殖民遗留问题，并在个人和机构层面推动实现非殖民化的可持续变革和建议。为了制定全球环境监测非殖民化的建议，该小组对有关全球卫生非殖民化的现有文献进行了一次非系统性的回顾，随后来自低收入、中等收入国家和高收入国家的学者进行了深入讨论，探讨全球环境监测的具体影响和挑战。然后，我们归纳了可操作的解决方案，为全球环境监测非殖民化提供建议。结果尽管有关全球卫生非殖民化的文献迅速增加，但针对全球环境监测这一相对较新的领域的指导却很少。通过将非殖民化原则应用于全球环境监测，我们提出了提高全球环境监测学术公平性的关键优先事项：（1）重新构建合作伙伴关系，将低收入、中等收入国家的学者置于专业和权力地位；（2）将研究资金转向由低收入、中等收入国家驱动的项目和研究人员；（3）在确立作者身份时采取更公平的做法；以及（4）在对来自低收入、中等收入国家和高收入国家的环境监测受训人员进行教育时坚持非殖民化原则。结论了解 GEM 的殖民根源将使我们能够以更批判的眼光看待当前的健康差距，并识别我们行业中继续坚持这些错误观念的不公平制度化做法。全球环境监测非殖民化的未来取决于我们对殖民时代做法的认识和纠正，这些做法形成了医疗保健服务和科学进步的结构性决定因素。

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Building a framework to decolonize global emergency medicine

Background

Global emergency medicine (GEM) is situated at the intersection of global health and emergency medicine (EM), which is built upon a history of colonial systems and institutions that continue to reinforce inequities between high-income countries (HICs) and low- and middle-income countries (LMICs) today. These power imbalances yield disparities in GEM practice, research, and education.

Approach

The Global Emergency Medicine Academy (GEMA) of the Society for Academic Emergency Medicine formed the Decolonizing GEM Working Group in 2020, which now includes over 100 worldwide members. The mission is to address colonial legacies in GEM and catalyze sustainable changes and recommendations toward decolonization at individual and institutional levels. To develop recommendations to decolonize GEM, the group conducted a nonsystematic review of existing literature on decolonizing global health, followed by in-depth discussions between academics from LMICs and HICs to explore implications and challenges specific to GEM. We then synthesized actionable solutions to provide recommendations on decolonizing GEM.

Results

Despite the rapidly expanding body of literature on decolonizing global health, there is little guidance specific to the relatively new field of GEM. By applying decolonizing principles to GEM, we suggest key priorities for improving equity in academic GEM: (1) reframing partnerships to place LMIC academics in positions of expertise and power, (2) redirecting research funding toward LMIC-driven projects and investigators, (3) creating more equitable practices in establishing authorship, and (4) upholding principles of decolonization in the education of EM trainees from LMICs and HICs.

Conclusions

Understanding the colonial roots of GEM will allow us to look more critically at current health disparities and identify inequitable institutionalized practices within our profession that continue to uphold these misguided concepts. A decolonized future of GEM depends on our recognition and rectification of colonial-era practices that shape structural determinants of health care delivery and scientific advancement.

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