Global Health with its feet on the ground

06/03/2018 - Flavia Bueno

Every year, actions carried out by global health actors multiply. However, the benefits and results that many of these projects seek to achieve seem not to reach their target populations.

Imagine you are in the Northeast of Brazil, in an inland city. A family with three children, one of them with just under two years of age. Something, however, does not seem right. The child, who should already be walking with his own feet, remains in his mother’s arms. Its development was hampered by a simple bite to his mother, when she was still pregnant, by a mosquito that for decades has been transmitting diseases in various regions of the country, the Aedes Aegypti.

This family, whose reality was completely changed by one stroke from the Zika epidemic and its consequent neurological disorders, is part of what public policy makers and decision makers at the global level would call the ‘target population’. In decisions taken thousands of kilometers from their homes, in global instances such as the World Health Organization, researchers, state agencies, and financing of various natures were mobilized in what eventually became a global emergency. With measures of this magnitude, one would believe that a family like this would be very well assisted.

However, the decisions taken in the field of Global Health seem to be very far from the people they wish to reach, because those people are not heard. This is how the critical perspective of global health1 understands it, as presented by João Biehl, a researcher at Princeton University, and Adriana Petryna, from the University of Pennsylvania. For them, listening to people serves, not only for the evaluation of implemented projects, but also for their design.

Beyond what is described as the target population, there is a context that includes social, economic, political and cultural determinants. The attempt to homogenize them in demographic or geographic categories remains on the surface.

This attempt has obvious advantages for measuring and evaluating results of what is being implemented, so that, after their evaluation, these projects can receive more financial resources, or are eligible to receive funds from this or that organization, among others. For the Brazilian geographer Milton Santos2, however, homogenization is typical of a ‘fable’ of globalization and does not offer a reliable image of reality.

According to him, globalization as it is portrayed today does not exist in fact, it is a perversity, since its benefits (the idea of ​​the narrowing of space-time, access to technologies and information, global village, etc.) only reach a small part of the world’s population. Thus, contrary to what some would have us believe, local differences are actually bigger and stronger. Therefore, sciences and techniques unite to conform the unique discourse that creates the current idea of ​​globalization.

Despite the importance of evaluations based on metrics and epidemiology, there are other instruments, such as ethnography that should be understood as equally relevant in dealing with complex issues, lives and social groups. This involves, anthropologists collecting data, working in the field with the people and being in contact with their cultures.

According to Biehl and Petryna, this approach has advantages for projects carried out by global health actors, because “by shifting the emphasis from diseases to people and environments, and from trickle-down access to equality, we have the opportunity to set a humane agenda that both realistically confronts challenges and expands our vision of the future of global communities”1.

The recognition of otherness is one of the tasks of the anthropologist, and ethnography is a method that allows us to recognize and understand social phenomena in an integral way. Observing the way people and groups live, ethnography allows researchers to include people in research, with active participation in order to work for structural changes3.

Now, combining two philosophically different strategies can be a challenge that global health actors must take into account. Perhaps with an evaluation of this nature, the story with which we started this article would have a different conclusion: one that would include the perspective of those affected, with the impact that they would like to feel. This should be the result that every Global Health project aims to achieve.

From the beginning of its history, UNASUR has held respect for the interculturality of the South American region and social participation as pillars of its actions. With that in perspective, we must continue to remember these values ​​in all our actions, with the main objective of improving the lives of our people.

Read the other articles of Health to the South – March issue


  1. BIEHL, João; PETRYNA, Adriana. Peopling Global Health. Saude soc.,  São Paulo ,  v. 23, n. 2, p. 376-389,  2014. Available at <>. Access on 19 February 2018.
  2. SANTOS, Milton. Por uma outra globalização – do pensamento único à consciência universal. São Pauto: Record, 2000.
  3. MATTOS, CLG. A abordagem etnográfica na investigação científica. In MATTOS, CLG., and CASTRO, PA., orgs. Etnografia e educação: conceitos e usos [online]. Campina Grande: EDUEPB, 2011. pp. 49-83. Available at <>. Access on 28 February 2018.