An imagined future for global health research, policy, and practice: contradictions and change - A study using the example of adolescent sexual and reproductive health in Eastern sub-Saharan Africa

Abstract

Ongoing global health inequities have been amplified since the 2020 COVID-19 pandemic and subsequent social movements. Such inequities have resulted in increased literature critiquing the historical roots and current practices in global health. From this literature, questions have emerged about the future of global health and Canada’s role in this future. However, there is little research consolidating existing critiques and, based on these critiques, exploring adolescent sexual and reproductive health (ASRH) research and the role of Canadian funding for ASRH. The aim of this dissertation is to consolidate contemporary critiques of global health to develop a conceptual framework for one potential imagined future for global health. It then explores the conceptual framework for an imagined future through an example of global health research, policy, and practice, as it relates to ASRH in Eastern sub-Saharan Africa, to consider the opportunities and challenges of achieving this new potential vision. In this dissertation, I present four unique contributions. The first article presents the conceptual framework for an imagined future that will be used to explore ASRH research, policy, and practice. The second article presents findings from a scoping review on adolescent engagement in ASRH research. The third article presents a review of Canada’s Feminist International Assistance Policy (FIAP) and examines the development of the policy in relation to an imagined future. The fourth article presents a qualitative description of stakeholder perspectives who are implementing ASRH projects with Canadian funding and discusses these perspectives in relation to an imagined future. Conclusions suggest that language to support changes towards an imagined future in global health exists although there is continued opportunity to operationalize the changes. Further research is encouraged to engage local actors and consider practical ways to shift towards equity and justice in Canadian funding for ASRH.