Core Competency: Global Citizenship & Diversity
Global Citizenship and Diversity: The ability to demonstrate: a broader perspective on the impact of globalization on cultures; an enhanced ability to work inclusively and explain the benefit and value of diversity; and to analyze and understand the past, present, and future of global interactions with an attention to global economy, the environment, cultural transformation, and humanitarian disasters, among others.
Context
Course Information: GLBS2800: Contemporary Issues In Global Health
Creation Date: July 17th, 2024
Description of Artifact:
My GLBS2800 capstone paper The Violence of Hope explores the critical role of hope in global mental healthcare, emphasizing that while hope is essential to patient recovery and dignity, it remains undervalued in economic decision-making. Structural violence, such as poverty, discrimination, and inequitable access to care, erodes patients' optimism and perpetuates suffering, necessitating an apolitical remoralization of healthcare to include hope as a qualitative measure. My paper highlights the tension between traditional healing practices and modern medicine, arguing for more inclusive approaches which recognize the dignity of sufferers and their faith in localized treatments. Through examples such as Dr. Vikram Patel’s advocacy and Dr. James Kim’s fieldwork, the paper argues that introducing hope into the economics of local healthcare can challenge the dehumanizing aspects of global healthcare systems. Ultimately, it calls for healthcare policies which balance economic consideration with our moral imperative to sustain hope and human dignity in care delivery.
Skills, Knowledge of Abilities Demonstrated
Specific Skills/Knowledge:
Critical Thinking and Ethical Analysis:
My paper reflects a critical analysis of the intersection of mental health, structural violence, and healthcare economics, where I identify ethical issues such as inequity, discrimination, and the moral failure of excluding hope from healthcare decisions, drawing on interdisciplinary sources to frame such challenges.
Understanding of Structural Violence in Healthcare:
The paper demonstrates a nuanced understanding of structural violence as a concept which transcends physical harm, encompassing policies, economic systems, and societal structures risking harm to marginalized populations. It demonstrates an ability to apply this concept to mental health care, showing how economic and social decisions impact patients' hope and recovery.
Synthesis of Qualitative and Quantitative Measures in Healthcare:
My work highlights the tension between qualitative measures such as hope, and quantitative economic priorities in healthcare systems. It highlights an ability to reconcile these perspectives by advocating for the integration of patient experiences and optimism into healthcare policy and decision-making.
Interdisciplinary Research and Source Integration:
My argument draws from a broad range of sources, including academic articles, lectures, films, and case studies, which demonstrates strong research skills, the ability to synthesize interdisciplinary knowledge, and effective use of evidence-based arguments to support the ethical claims I conclude.
Advocacy for Human Rights and Equity in Healthcare:
My global citizenship artifact reflects an understanding and respectful sensitivity of human rights-based approaches to healthcare, particularly in mental health. It advocates for equitable healthcare policies which prioritize human dignity and include marginalized voices in decision-making processes.
Connection to the Core Competency
Relevance:
Understanding the Impact of Globalization on Healthcare: The paper demonstrates how globalization shapes healthcare policies, particularly the negative effects of global economic decisions upon marginalized populations in developing countries, where structural violence has eroded hope and dignity in localized systems of mental health care.
Advocating for Inclusive Healthcare Practices: My paper emphasizes a need for inclusive healthcare policies which respect diverse cultural practices, such as traditional faith-based healing methods, and argues for bridging the gap between Western medicine and localized treatments to provide more equitable and culturally charitable care.
Analyzing Global Interactions and Structural Inequities: The work highlights the historical and ongoing impact of global economic structures which continue to perpetuate inequities in healthcare access, and focuses on the disproportionate suffering of marginalized communities, especially those in under-developed counties, and the need to address these inequalities through a human rights lens.
Promoting Diversity and the Value of Human Dignity: I argue for recognizing more diverse cultural understandings of hope and healing, acknowledging the importance of both modern medical practices and traditional, faith-based methods in promoting dignity and optimism within patient care.
Connecting Healthcare to Humanitarian Crises and Human Rights: By framing mental health as a humanitarian and human rights issue, my paper connects healthcare disparities to broader global crises, such as poverty, discrimination, and access to care, and ultimately calls for a remoralization of global healthcare systems to ensure dignity and hope for all individuals.
Challenges and Solutions
Challenge: Synthesizing Complex Interdisciplinary Concepts
Solution: I addressed this by carefully selecting key themes from diverse sources, including academic articles, films, and lectures, and then synthesizing them into a cohesive narrative which connected issues of ethics, healthcare policy, and structural violence.
Challenge: Balancing Ethical and Economic Perspectives
Solution: I resolved this by integrating both qualitative and quantitative approaches, and highlighting the moral imperative of hope alongside the economic arguments for investing in globalized patient-centered care.
Challenge: Addressing Cultural Sensitivity and Inclusivity
Solution: I ensured a necessary cultural sensitivity by acknowledging the value of traditional healing practices and advocating for their coexistence with modern medical solutions, emphasizing the importance of dignity in diverse healthcare contexts.
Challenge: Managing a Large Volume of Research Material
Solution: I organized my research by categorizing sources based on themes such as structural violence, mental health, and human rights, and then extracting several key points to support the argument without overwhelming the narrative.
Challenge: Communicating Complex Ideas Clearly and Persuasively
Solution: I focused on clarity in my argument by breaking down complex ideas into accessible language and structuring the paper with a logical flow, ensuring the ethical argument for hope was both compelling and easy to follow.
Impact on Professional and Academic Growth
Professional Growth:
Writing this paper has significantly contributed to my professional growth by enhancing my ability to analyze global healthcare issues through ethical and economic perspectives. It deepened my understanding of structural violence, global economic inequities, and the importance of human dignity in healthcare. The process improved my research, synthesis, and communication skills, enabling me to craft more impactful and well-rounded arguments which balance quantitative data with qualitative human experiences. Additionally, it strengthened my sense of cultural competency, reinforcing the value of how to implement inclusive practices in diverse settings, a practice highly applicable to my current workplace. This experience has inspired me to advocate for more equitable, human-centered solutions and approach leadership with empathy and a stronger commitment to social justice.
Academic Growth:
This paper greatly contributed to my academic growth by enhancing my critical thinking, research, and analytical skills. I still feel it is one of the strongest pieces I wrote at Penn. The process required synthesizing complex interdisciplinary concepts, such as structural violence, healthcare equity, and necessary cultural sensitivity, into a cohesive argument supported by diverse sources. It deepened my understanding of global mental health challenges and the ethical implications of healthcare policies. This experience improved my ability to integrate qualitative and quantitative perspectives, balancing human dignity with economic realities. It also taught me to approach academic work with a more inclusive, global mindset, and foster a deeper awareness of issues of social justice.
Self-Evaluation
Rubric Score You Think You Earned For This Submission: 20
This was one of the most challenging, but ultimately rewarding papers to write in its connecting of global healthcare problems to broader cultural, economic, and humanitarian issues. In doing so, it synthesizes academic knowledge with real-world implications, emphasizing the importance of inclusive, patient-centered care across diverse contexts, a practice which I have already begun to apply to my work in the NBC newsroom. My reflections conclude that fostering cultural sensitivity and promoting human dignity are essential for creating equitable global health policies, but they have also highlighted how writing this paper changed my understanding of the world beyond my lived experience. A genuinely transformative experience, it powerfully brought the heartbreak of global economic underinvestment into my academic experience at Penn.
Survey
This artifact helped me demonstrate growth within the competency of Global Citizenship & Diversity by critically examining how structural violence and global economic inequities shape mental healthcare access and outcomes, particularly for marginalized populations. By advocating for culturally inclusive and patient-centered care, the paper deepened my understanding of the importance of balancing modern medical practices with traditional healing methods to uphold human dignity. The process strengthened my ability to analyze global challenges through an ethical and humanitarian lens, fostering a commitment to equity, cultural sensitivity, and social justice. This work has inspired me to approach both academic and professional challenges with a more inclusive and globally informed perspective.
Artifact:
Capstone Reflection: The Violence of Hope
As Doctor James Kim describes, “optimism is a moral choice” (1:30:13 in Davidson & Kos, 2017). How important is hope to the global healthcare initiative? How might we reconcile the asymmetry of the qualitative benefits hope brings to suffering and mental health with the structural violence which causes optimism to erode in patients? Hope is a key measure of qualitative success on the ground, but challenging to quantify in upstream decisions focused on the economics of how that same hope might be delivered. Asymmetrical hope-destroying decisions of discrimination, hidden suffering, shame, and human rights abuses are characteristics of lowered life expectancy, driven by inequities in global mental healthcare, and have motivated Dr. Vikram Patel to describe it as a human rights crisis (9:21-12:11 in Patel, 2012). Citing Kleinman, who expresses it as a failure of humanity, both argue there is no greater failure than removing an individual’s hope of recovery (Kleinman, 2009). Both ask where the outrage is in rebalancing the moral imperative to help those who suffer in a world increasingly treating mental illness with pharmaceutical solutions and imposing healthcare decisions upon those without a seat at the table (Patel & Farmer, 2020).
This remoralization of hope is one which seeks to include qualitative measures of patient optimism into economic decisions of mental health, and dismantle the structural violence which would seek to remove it (Farmer, 1996). Such remoralization still asks us to make choices and determine hierarchy, but the inclusion of hope as a measure demands we bring the patient into the mathematics. It forces us to see patients not data (Krol in Petryna, 2013). Who gets to extend hope to whom is still a privilege of those making choices upstream of the very suffering they seek to alleviate. As Kleinman describes, the goal of such remoralization is to destigmatize mental health and to improve morale in the patient, but we still return to a central problem of the cost of care (Kleinman, 2009). As Fassin describes, "what we're looking at here is the worth of lives versus the value of life" (Fassin in Joiner, 2024). If we morally assert that all life has value, as Patel argues, then we must also make the economic argument that all lives have worth and that hope as a dimension of dignity in suffering is critical to care (Patel, 2012). The moral argument to introduce hope as a measure appeals to an emotionally positive outcome, but still cries out for an economic reconciliation.
The ancestry of suffering is often informed by a constellation of social, economic and political forces which over time coalesce around the destructive, hopeless structural violence of poverty. As The World Health Organization describes, “poverty wields its destructive influence at every stage of human life” (Farmer, 1996). But poverty goes beyond the economic asymmetry of structural violence. It robs those who suffer of hope, where the moral imperative to help is often fatally hampered by delay, which itself erodes optimism. Agency, access, and an disproportionate relationship between traditional and modern healing methods, both of which are paths to hope, collide to exacerbate suffering in the rural poor. In the film Bending The Arc (37:48-39.52 in Davidson & Kos, 2017), a young patient, Melquiades, lingers with long-term multi-drug resistant tuberculosis, but also chronic despair and exhaustion. A victim of disease, but also the structural violence imposed upon poor countries by economic administrations which withhold multi-drug resistant medication as ‘an expensive luxury’ and assign the violence of value to a hierarchy of human life. Melquiades’ loss of hope accelerates his decline. A fatal violence which creates winners who get to hope and losers who don’t.
Patients suffering from hopelessness also exhibit reduced agency through the structural violence of a lack of education, and from distant administrative decisions prioritizing market forces over individual suffering (Farmer, 1996). This is compounded by a lack of communal access to modern medicine, which drives patients towards supernatural healing methods, and where the only modern available alternative is unregulated. Both traditional methods and unregulated modern care bridge the gap of hope between suffering and recovery (Banerjee, 2013). They offer an optimism which comes from treatment irrespective of origin. The faith patients place in their localized methods of healing are often their only, uneducated, ineffective hope, where the unquestioning faith we place in western medicine similarly immunizes us from the kind of suffering which results from a lack of hope. The privilege of medical hope being within reach asserts itself over faith-based treatments, but is also a delineation across social and economic means. Those with means are afforded hope. It causes us to construct a perspective where the supernatural mysticism valued by suffering communities in less developed parts of the word is viewed as as less hopeful than the science of western medicine. A value system which prejudices western medicine over mysticism, and discards the hundreds of years of lived experience for which such methods have been in practice. It’s not that we seek to enlighten the traditional with scientific method, but seek more inclusive pathways for them to coexist within a sensitive, dignified lens of optimism for the sufferer.
Reframing optimism is a moral choice, but also one of economics (Kleinman, 2009). One which places accountability on a system which takes the hopeless environment of suffering and applies qualitative solutions to it through quantitative resourcing. Hope is not cure, but it is life-giving to those who suffer. Hope is a key counter-measure to structural violence and negative illness narratives (Kleinman, 1989). As Doctor James Kim describes, “the key is to have a pessimism of the intellect, but an optimism of the will” (1:32:29-1:32:56 in Davidson & Kos, 2017). The economic approach itself must be infused with hope. As Kim’s program proved successful on the ground in developing countries, it empowered Kim and his colleagues to make the argument for investment at the economic source of the violence, but also to place hope at the center of their treatment. When Melquiades recovers, Kim becomes emotional. “To think we almost let him die. Just because we didn’t think he deserved it” (40:08-41:32 in Davidson & Kos, 2017). It’s optimistic treatment on the ground paired with economic argument grounded in hope at the source which bends the moral arc of history towards a more hopeful future.
References:
Banerjee, A. (2013). The Name of the Disease. [Video File]. YouTube.com. Retrieved from: https://www.youtube.com/watch?v=rOenEuclS30.
Davidson & Kos. (2017). Bending The Arc. [Video File]. Retrieved from: https://video-alexanderstreet-com.proxy.library.upenn.edu/watch/bending-the-arc.
Farmer, P. (1996). On Suffering and Structural Violence. Daedalus , Winter, 1996, Vol. 125, No. 1. [Digital File]. Retrieved from https://www.jstor.org/stable/pdf/20027362.pdf.
Joiner, M. (2024). Week 4 Required Lecture. [Digital File]. Retrieved from: https://canvas.upenn.edu/courses/1781220/pages/week-4-required-lecture-47-00?module_item_id=29900561.
Kleinman, A. (1989). The Illness Narratives: Suffering, Healing, And The Human Condition. Basic Books. [Digital File]. Retrieved from: https://canvas.upenn.edu/courses/1781220/files/133613891?module_item_id=29900548.
Kleinman, A. (2009). Global mental health: a failure of humanity. The Lancet. Vol. 374. August 22 2009. Retrieved from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61510-5/fulltext.
Patel, V. (2012). Why Mental Health Matters to Global Health. McGill Transcultural Psychiatry. [Video File]. Retrieved from: https://vimeo.com/48897107.
Patel, V. & Farmer, P. (2020). The moral case for global mental health delivery. The Lancet. Vol. 395. January 11 2020. Retrieved from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)33149-6/abstract.
Petryna, A. (2013). The Right of Recovery. Current Anthropology. Volume 54, Supplement 7, October 2013. [Digital File]. Retrieved from: https://www.journals.uchicago.edu/pb-assets/docs/journals/CA_S7_v54nS7_potentiality_supplement-1593017836633.pdf.
