Dismantling the feudal structure of global health by promoting traditional medical knowledge in global health ecosystem

‘All things are subject to interpretation. Whichever interpretation prevails at a given time is a function of power and not truth.’ This quote by Friedrich Nietzsche reminds us of the role of the power structure in any system. The global health ecosystem is no exception to this phenomenon. The editorial published in BMJ Global Health ‘The feudal structure of global health and its implications for decolonization’ by Vikash Keshri and Soumyadeep Bhaumik,¹ compares feudal structure to the contemporary global health ecology. They also use an apt word Zamindari to describe the hierarchical structure. Destruction of traditional knowledge is also cited as a key effect of the hierarchical thinking on the global health environment. This is of some concern vis-a-vis the role of traditional knowledge in the public health context. By adopting a restricted, reductionist and monotheistic framework, this stringent hierarchy precludes the entrance of a new knowledge ecosystem.

We advocate the adoption of traditional medical knowledge, such as Ayurveda (the Indian system of medicine), as one of the ways to create an open structure of the global health ecosystem. The greatest obstacle in this process is the lack of acceptance and mainstreaming of traditional medical knowledge in order to retain the predominance of high-income countries in the process of knowledge development. Instead of accepting the broader foundation of traditional knowledge, it categorically disregards it as unscientific. On the contrary, the same ecosystem uses this traditional knowledge to identify novel active molecules for various elements and to reject the world view of these traditional medicine systems on the body, health and illness.² From a traditional medicinal perspective, focus on active components may not be applicable; for instance, ayurveda prescriptions frequently involve holistic yet personalized or therapeutic approaches.³

Traditional medical systems such as Ayurveda and Yoga conceptualize the human and nature interaction differently than western biomedicine. Western medicine’s dichotomies are not suitable for integrating these indigenous knowledge systems into the global health ecosystem. To accomplish this, stakeholders from low- and middle-income countries (LMICs) with a rich history of traditional medical knowledge should open themselves to the value of their traditional knowledge. The reductionist evidence-generation techniques of biomedicine may not be always suitable for traditional knowledge systems. Researchers should develop innovative methods to generate data to establish the efficacy of utilizing traditional knowledge systems as a whole.⁴

The governments in LMICs should improve the ease of conducting research by increasing funding and building research capacities to boost local health knowledge systems. The initiative by the Ministry of Ayush (MoA), Government of India is important in this context. The MoA systematically implemented steps to promote the study and use of traditional medicine in India during the Covid-19 pandemic. The ministry formed an Inter-disciplinary AYUSH Research and Development Task Force that facilitated several studies on Ayush interventions.These involved over 150 institutions and investigators from diverse disciplines. This is an important example of integrating ayurvedic medicines into the global health environment.⁵ The stakeholders from LMICs involved in research and development of traditional medicine must build a unified front to expedite efforts to mainstream traditional medical knowledge in the global health ecosystem. It is a difficult journey filled with ontological, epistemological and linguistic challenges that will require the creation of a new vocabulary to explain the critical and complex world views expressed by various traditional medical systems. Interdisciplinary and inclusive approach is required in order to prevent global health from succumbing to this feudal structure. The real challenge is the mindset. It needs an open mind to transform the global health ecosystem. We need to embrace traditional knowledge systems to end Zamindari in the global health ecosystem.