It’s easy to look back on past global health work and pick it a part. Did I really help anyone? Did I do more good than harm? Was I doing sustainable work? With so much academic discussion over these questions, I sometimes feel paralyzed into inaction, worried no work I take part in could ever be good enough. Intentions are a common part of this critique with the notion that good intentions are not enough to do effective global health work. Some have gone so far as to say, “to hell with good intentions!”. But while they aren’t enough alone, good intentions do count for something. We get so caught up in the academics of global health and decolonizing the field that I think we often forget this.
When I reflect on the history and the transformation from colonial medicine, international medicine, and now global health equity, you can’t deny intentions matter. With colonial medicine, the intention was to maximize extraction by optimizing the health of the indigenous people producing what was being extracted. This has led to persistent inequities that the current field of global health equity aims to address. The colonists’ intentions were extraction and they were extremely successful at it. They were successful to the point that as a white descendent of Europeans, I’m still benefiting several hundred years later. So yes, intentions aren’t everything, but they are both important and highly influential in the outcome of our work. We need to constantly continue to re-evaluate our intentions and the work that we are doing to make sure they both align with equity. If we do this, it’s possible to move from inaction to meaningful and effective action.