Illness Narratives In Global Health

Storytelling is a powerful tool that allows us to relate to one another across borders, cultures, and experiences. It is a significant aspect of global health. Images associated with international health are those of pediatric patients in low and middle-income countries (LMICs) with descriptions of ailment or news stories on television of an outbreak in a faraway country. These stories capture our attention and allow us to process situations far removed from ours. While stories allow us to communicate the urgency and extent of international health topics, there are challenges associated with illness narratives. It is important to examine how stories are told in medicine, and specifically in global health. It is critical to question who tells stories, how they’re told, and what their impact is. These can be stories of individual patients in a country, medical aid organizations, or even stories of a country’s health infrastructure.

A recent Lancet essay titled “Global Health 2021: Who tells the Story” examines the role of journals when it comes to research in academic global health. The essay cites data showing a lower number of publications authored by those affiliated with or came from LMIC in The Lancet Global Health(1). Here, the authors reflect on how, as a London-based global health journal, they need to examine the narration disparities. They note that an imbalance in authorship is a symptom of an imbalance in power when it comes to academic global health.

This essay was in part motivated by a crucial article by Seye Abimola and Madhukar Pai. In their article examining the decolonization of global health, Abimola and Par state “even today, global health is neither global nor diverse. More leaders of global health organisations are alumni of Harvard than are women from low-income and middle-income countries. Global health remains much too centred on individuals and agencies in high-income countries (HICs).”(2) This important point highlights the distance between the subject of stories and those who tell them. This can limit diversity in perspective while taking away ownership of stories from those who experience it.

An article looking at illness narratives in an outbreak reported that when it comes to Ebola, Zika, and SARS, marginalized communities often bear the burden of disease while their account of illness is often neglected. The authors state, “regardless of income setting, there is a need to give voice to the most marginalized communities during an epidemic.”(3) This point on narration should extend beyond authorship in research to include news coverage of global health events. The way the Ebola outbreak and even early days of COVID pandemic were portrayed are examples of the dangers associated with lack of nuance in the way global health topics are discussed in the media.

Inclusivity of illness narratives around global health can allow us to avoid pitfalls that lead to widespread misinformation and discrimination. In addition to examining who tells the story, it is also important to explore how stories are told. An essay highlighting the challenges of storytelling in medicine notes that at times the trauma of subjects has been exploited by international charities. The article states the importance of communicating stories in a way that does not “feast on the trauma of others”(4). 

At the core of his argument is the need to examine how we communicate the stories of others. As described above, allowing locals to tell stories regarding their experience of illness, outbreaks, and research can help us deal more carefully with the associated trauma. Stories told without careful consideration can lead to widespread misinformation and potentially harmful generalizations. As we move towards examining how we improve global health delivery, it is critical to explore how we can improve the stories we share. In order to create a better system to communicate important global health topics, it is imperative to challenge the ways we receive information constantly.

This will broaden our understanding of complex issues and allow us to consider alternative solutions.

To this end, the following five questions should help us navigate the challenges of global storytelling. These questions are suggested to help guide our approach towards a more

1. Has the subject given informed consent to tell their story?
2. How is the story presented?
3. Is there a way to allow the story subject to be
4. Do the stories told reinforce harmful stereotypes?
5. Are there negative consequences to the subject if the story is told?