Category Archives: Leadership

The Foreign Gaze: A Review

Seye Abimbola’s book, The Foreign Gaze, is a thoughtful and often elegantly written account of how power distorts knowledge production in global health. Drawing on personal experience and philosophical insight, Abimbola introduces the concept of “the foreign gaze” to describe the way researchers, particularly from low- and middle-income countries (LMICs), shape their work for external audiences—northern donors, editors, reviewers, and institutions. The result, he argues, is a system where knowledge is produced not for the people it is intended to serve, but for those who control its global circulation and validation.

The strength of the book lies in its clear moral purpose. Abimbola calls for greater attention to “pose” (the standpoint of the knower) and “gaze” (the intended audience), and argues for an ethic of epistemic justice—where local actors are not just included in global conversations but are recognised as authoritative producers and users of knowledge in their own right. He speaks with conviction about the daily indignities of exclusion and marginalisation, and the ways in which academic global health often fails those working at the front lines of health systems.

And yet, for all its rhetorical clarity and moral force, The Foreign Gaze is ultimately an unbalanced critique. It targets external systems of authority—foreign reviewers, northern journals, donor agendas—without seriously interrogating the internal dynamics of epistemic dependence within LMICs themselves. In doing so, it offers a partial, and sometimes evasive, account of the problem it sets out to name.

First, the book is morally lopsided. Abimbola presents the Global South as the passive object of northern scrutiny, not fully acknowledging how deeply southern actors participate in, benefit from, and scaffold the system he critiques. Nor does he describe the effort that Global South actors will go to, to be seen by the Global North. Ministries of health design policies to satisfy donor templates. Researchers tailor proposals to align with northern funding calls. Academic careers are built on publishing in northern journals and securing foreign recognition. These are not the actions of helpless victims; they are rational and strategic choices made within unequal systems. Yet Abimbola offers little analysis of this internal complicity and treats the relationship as Manichean: colonial = bad, indigenous = good.

This lopsidedness extends to his treatment of knowledge. At key moments, he blurs the line between affirming the dignity of knowers and valourising the truth of what they claim to know. He rightly insists that people must not be dismissed because of their institutional distance from power—but he often slides into assuming that local practices are not only morally meaningful but epistemically equivalent to biomedical science. This argument is especially evident in his discussion of Nigerian group antenatal care, which he treats as if it should be shielded from empirical evaluation, even while dismissing external attempts to rigorously assess it. The suggestion is that foreign testing is not just misplaced but offensive.

Yet this defence reveals a more profound contradiction. The Foreign Gaze claims to champion epistemic justice but curates who counts as a knower. Abimbola elevates midwives, grassroots health workers, and insider academics, but gives little attention to the knowers within communities whose influence may be coercive, regressive, or misinformed. The dignity of knowers, in his account, is reserved for those whose knowledge can be rendered morally resonant. In this way, the book replicates the very asymmetries it aims to dismantle: it replaces epistemic exclusion with selective inclusion, rather than with principled universality.

Though Abimbola does not argue for relativism outright, his privileging of proximity lacks an accompanying framework for testing or contesting local knowledge. In practice, this leaves him affirming certain local claims without clear criteria, especially when those claims conflict or reproduce harm. By challenging foreign authority without articulating how legitimacy should be assessed within local contexts, he risks substituting one opaque hierarchy for another. The absence of a mechanism for epistemic accountability within the ‘proximate’ space undermines the critical edge of his argument.

Second, the book is epistemically incomplete. It assumes that valuable local knowledge lies waiting to be recognised if only the foreign gaze would look away. While Abimbola acknowledges that local experts often tailor their work for foreign audiences, he avoids more profound questions about how this orientation emerged and why it endures. He does not examine how colonial and missionary legacies have shaped the epistemic cultures of southern institutions, or why local scholars rarely seek to theorise indigenous practices on their own terms. For instance, he praises group antenatal care in Nigeria as a locally grounded example, but never considers how inherited pedagogies already structure such practices. The deeper question is, why has so much southern knowledge production become mimicry rather than innovation?—remains largely unexplored.

This omission is particularly striking in light of historical examples like the suppression of variolation in colonial India. Indigenous practitioners had developed a functional method of smallpox inoculation, yet this knowledge was not allowed to evolve because colonial authorities replaced it with vaccination. The British enforced an epistemic closure from the outside, but the long-term effect was an internalised deference to another’s science. Abimbola touches none of this. He writes as if the gaze is the primary agent, and the south merely its object, ignoring the centuries of adaptation, aspiration, and abandonment that have shaped southern scientific cultures from within.

Finally, the book is strategically ineffective. It underestimates how profound a shift would be required to build independent knowledge systems in the Global South–to shed centuries of epistemic entanglement with the North. To reorient from the foreign gaze is not a matter of redirecting papers to different journals or holding conferences in other cities. It would require building entire epistemic infrastructures: funding mechanisms, review systems, training institutions, and incentive structures capable of rewarding intellectual independence rather than recognition. Abimbola offers no roadmap for this transformation. Nor does he seriously consider whether the current generation of southern institutions—so deeply entangled with northern agendas—could or would lead such a project. In this sense, the book gestures toward autonomy but remains captive to the very structures it critiques.

The core of the problem is this: The Foreign Gaze critiques the act of being watched, but says little about the desire to be seen. It offers a sharp analysis of how knowledge is distorted by foreign audiences, but not of why southern actors so often turn toward those audiences in the first place. Without that second half, the argument remains morally insufficient and structurally incomplete. Finally, it calls for justice, but offers no confrontation with the habits of thought, aspiration, and institutional design that prevent it.

In privileging proximity and local accountability, Abimbola gestures toward a world where “global health” no longer holds together as a coherent epistemic or institutional project, but he stops short of naming this dissolution or reckoning with its consequences.

The Foreign Gaze opens a critical conversation but does not complete it. If epistemic justice is to mean more than moral appeal, it must reckon with both the gaze from without and the longing to be seen from within. Until then, the project risks becoming, in the end, just another performance in the theatre of Northern validation.


Seye Abimbola (2025). The Foreign Gaze: Essays on Global Health. OpenEdition Books: Marseille.

The Star Trek Captain, Jean-Luc Picard as the Borg character Locutus

Resistance is necessary

I complain. A lot. I am not a happy person. But you will never die wondering what I thought or where I stood. Still, complaining isn’t enough, and whinging can feel futile.

The Borg and the rising authoritarian states of the 21st century want you to believe that “resistance is futile.” It isn’t. Resistance is not only necessary; resistance is an obligation.

Small acts of everyday resistance can raise the costs of authoritarianism so high the system collapses. In the late Soviet Union, acts of passive resistance—from workers deliberately slowing down production to citizens openly defying censorship laws—contributed to the erosion of state control. These acts of everyday resistance helped to chip away at the crumbling foundations. Authoritarian regimes rely on compliance to function. When enough people withdraw their cooperation, inefficiency turns into paralysis, and paralysis into collapse. It becomes so grindingly inefficient and ineffective that it fails. The unwillingness of the people to work in the interests of an illegitimate state is that state’s undoing.

Small acts of everyday resistance need not rise to criminality. There are ways of resisting that work, that keep the pressure up, and that allow you to control your level of exposure.

The power of the authoritarian state does not lie in compliance alone. It also lies in isolation—your sense of being alone in your unhappiness. Why do you think the Chinese state is so quick to remove online complaints and hide protests? The protest is not the problem. The protest’s effect is letting others know they are not alone in their unhappiness. And if you do not feel alone, you are also more likely to engage in small acts of everyday resistance.

Work to rule is a classic form of everyday resistance. This tactic has been historically effective in labour movements, such as the bureaucratic slowdowns under oppressive regimes, where workers deliberately followed every regulation to the letter to hinder authoritarian efficiency. Do your job. To the letter. No more. No less. When only one person works to rule, they are a miserable, unhelpful arse. When large numbers of people work to rule, unhappiness shows. It is palpable. In a government department that is engaging in immoral and cruel behaviour (“within the law”), you can slow it down, throw sand in the gearbox, and make it less cruel by being less effective and less efficient.

In the U.S., ICE agents could do their jobs—badly. Administrative staff supporting ICE agents can slow things down by moving paper at an excruciatingly necessary pace. The word “expedite” should be struck from the vocabulary.

Singapore in the late ’80s and ’90s was a highly (overly) regulated society. Many would say it has persisted. But in the ’90s, chewing gum became a tool of everyday resistance. People would stick it over the door sensors on the MRT trains. The doors couldn’t close, and it would bring the system to a grinding halt. The act was small, non-specific in its target, and (back then) unidentifiable.

Posters, protests, badges, public art, and internet memes have all been used to demonstrate everyday resistance. Remembering when the state wants to forget or reimagine a truth is a powerful corrective. Archive the truth on the internet.

In a digital age, careful choices about how and when to use devices, credit cards, and online accounts can disrupt data collection and tracking. Using burner phones where you can get them, paying with cash instead of cards, and setting up anonymous online accounts are small but effective ways to limit surveillance and maintain privacy. Resistance is not about criminality; it is about the right to privacy, the freedom to think, and the quiet power of refusing to comply—to engage in cruelty. Even small acts of everyday resistance remind others they are not alone.

It is possible to resist and chew gum at the same time.

Resources:

If you want some ideas, have a look at these two.

Trump v. Thucydides

Today is one month and one day(!) since the inauguration of Donald J. Trump for his second term as President of the United States (US).

In that time, he delighted in claiming dominion over Greenland, the Panama Canal, and the Palestinian territory of Gaza. He has humiliated treaty allies, cuddled up to recently acknowledged enemies of the US and her (former?) allies, and threatened trade wars against friends and foes alike. He has unleashed Elon Musk on the federal bureaucracy, effectively closing congressionally legislated departments. He has withdrawn life-saving medicines from millions of people around the world and declared ethnic cleansing a US policy.

Donald Trump is stomping on the norms of US democracy. He has the constitutional pardon power in one hand and US Supreme Court protection from prosecution in the other. He is basking in the absolute power of a monarch and turning the global, rules-based order (of which the US was the principal architect) into a plaything.

Louis XIV of France (reign: 1643–1715)—the “Sun King”—owned canons bearing the inscription Ultima Ratio Regum (“The Last Argument of Kings”). It was a pun-filled reference to the idea that the ultimate recourse of a ruler is violence. He was reminding friends, enemies, and subjugates that when his laws (canon) failed, his capacity for violence (cannon) would triumph.

Political Realists see Louis’s cannons as reifying the political idea that “might is right” (MiR). That is, power and not morality ultimately determines outcomes. As they watch Donald Trump tear down democracy and attack the global rules-based order, they make coded references to the ancient Greek historian Thucydides—hero of Realpolitik and the guy who wrote the History of the Peloponnesian War. It is to him the phrase “might is right” is attributed, based on a brief passage known as the Melian Dialogue.

The dialogue is a brutal exchange between envoys from Athens and the leaders of the small island of Melos—the same Melos famous for the statue of the Greek goddess Venus (“di Milo”). The Athenians explained that neutral Melos would have to side with Athens in their war against Sparta or be destroyed by the larger army of Athens. They did not prevaricate of sugar-coat the delivery of their message. And it is this exchange that has been reduced to MiR.

There are, however, significant problems with this position. First and foremost, Thucydides never actually wrote, “might is right”—not even close—and the suggestion that he did becomes a self-serving distortion used to justify ruthless power politics. Thucydides actually recorded the Athenian envoys saying, “The strong do what they can, and the weak suffer what they must.”

To be pedantic—necessarily so—he actually wrote, “οἱ μὲν δυνάμενοι πράσσουσιν, οἱ δὲ ἀσθενεῖς ξυγχωροῦσιν.”

The nuance in translation is crucial. The standard English rendering, “The strong do what they can…” relies on the modal verb “can,” which in English (and in French with pouvoir) suggests freedom of will—the idea that those with power act as they choose. But ancient Greek had no direct equivalent to modal auxiliaries like can or must.

The critical verb here is δυνάμενοι, a participle of δύναμαι (to be able). Rather than conveying a sense of willfulness, it implies something closer to necessity—that the strong act as circumstance dictates in accordance with their power, just as the weak yield because they also have no choice. This translation reflects the broader Thucydidean theme that power operates under the constraints of ἀνάγκη (necessity).

It is tragedy rather than psychopathy that is the binding relationship between Athens and Melos. Melos, for all its appeals to justice, is doomed. It refuses to bow to Athenian demands and is annihilated. However, the fate of Athens itself is no less bleak. The logic that drives The Athenians to subjugate Melos ultimately consumes them as well, leading to their downfall in the Sicilian Expedition and, eventually, their total defeat in the war. The same compulsion that led them to destroy Melos leads to their destruction.

Thus, when “might is right” is used too quickly to explain the actions of a leader, there is a danger that political scientists give moral cover to the immoral. They fall back on relativistic notions that the whim of the caveman with the bigger club determines societal norms.

Donald Trump is not acting out of tragic necessity. He does not wield power because it has to be wielded. It appears that he does what he does because he is an aggrieved psychopath who revels in the opportunity to put metaphorical kittens in a sack and drown them.  

Thucydides would not recognise Donald Trump as any of the actors in the Melian Dialogue.

There was no necessity to put millions in the path of death by withdrawing life-saving treatment. There was no necessity to propose the ethnic cleansing of Gaza. There was no necessity to threaten to take a NATO ally’s territory. There was no necessity to begin to tear down the multilateral system.

A socially and fiscally conservative leader might share many policy objectives with Donald Trump and his followers. There is no necessity, however, to reach those objectives by choosing the most cruel and destructive path possible.

Donald Trump is not a brilliant or tragically compelled leader; he is a psychopath.

When the U.S. ‘leans out’ of Global Health

The most powerful country on the planet has just ‘leaned out’ of global health. Will the Global South take the opportunity to ‘lean in’?

Yesterday, at a lunchtime talk at the World Health Organization (WHO) Headquarters in Geneva, Dr Madhukar (Madhu) Pai spoke on “Shifting Power in Global Health”. His presentation drew on ideas he had recently published (with Bandara and Kyobutungi) in the Lancet. The talk picked up on a consistent theme—the entrenched power of the Global North in global health—often white and male, but not necessarily.

One of the ideas Pai promoted was that of “allyship”. Rather than leading in global health fora, he suggested that Global North researchers, practitioners, and policymakers need to become allies of Global South counterparts. The role is to encourage and support those from the Global South in leadership.

In the online chat, one attendee wrote,

“I also want to challenge the notion of allyship. I think what we need is people with power and privilege to ‘lean out’ and make space at the table for folks with less power to exercise their leadership.

In other words, worry less about being an ally. Get out of the way, and people in the Global South will have the space to step in.

The comment was particularly pertinent given the stated intention of the United States (US) to withdraw from WHO. WHO is the global body with the most sweeping engagement in global health and the US was about the ‘lean out’—a perfect natural experiment.

The Executive Order (EO)—“WITHDRAWING THE UNITED STATES FROM THE WORLD HEALTH ORGANIZATION”—was signed by Donald Trump on his inauguration, 20 January, 2025.

Trump tried to withdraw from WHO in 2020. He left it too late, and Joe Biden was able to rescind the order. Not this time! The new EO also pauses support for WHO immediately. Section 2d of the EO states, in part:

(d) The Secretary of State and the Director of the Office of Management and Budget shall take appropriate measures, with all practicable speed, to:

    (i) pause the future transfer of any United States Government funds, support, or resources to the WHO;

    (ii) recall and reassign United States Government personnel or contractors working in any capacity with the WHO;

The decision to withdraw is very unwise—a disservice not only to people in the US but to the global community. It jeopardises lives both domestically and internationally. However, if the goal is for those with power and privilege to make room at the table for others to lead, this structural shift could enable that. If the US withdrawal is unavoidable, the focus should be on leveraging it for the greatest possible positive impact.

It remains to be seen how aggressively the US government will enforce the immediate pause of “funds, support, or resources” (S.2(d)(i)). What is clear, however, is that funding will likely cease swiftly. There may be a brief trickle as any existing commitments are untangled, depending on whether the new administration feels compelled to honour agreements made by its predecessor. Regardless, the relationship with WHO is effectively ending. The same applies to the expertise of government employees and contractors (S.2(d)(ii)), which the US will also withdraw.

But what about the “support or resources” mentioned in S.2(d)(i)? The US withdrawal from WHO could also extend to the engagement of US universities and research institutions. This could include collaborative projects involving third parties where US institutions and WHO are partners. The extent of the impact will largely depend on how far the Trump administration is willing to go. Given its history, it could act aggressively to enforce the directive and interpret it permissively.

At its most extreme, the administration could target funding to US universities and research institutions, arguing that any expenditure providing even nebulous “support or resources” to WHO is a violation. US Universities could be endangered if the funds they have received require approvals from the State Department or the Office of Management and Budget. A single dollar of perceived “support” might jeopardise tens of millions in funding for these institutions. The mere threat of such action could intimidate university administrators, compelling them to redirect activities and disengage from collaborations involving WHO (even tangentially).

We have already seen billionaires and news organisations engage in “anticipatory obedience”. Why would we imagine that universities would be any less callow?

The danger here is two-fold. The first problem, as identified by Wiyeh and Mukumbang in their Lancet letter responding to Pai’s article, is the question of capacity. If the US expertise from researchers, practitioners, and policymakers vanishes, how much of the resulting gap can realistically be filled by the Global South? If stakeholders from the Global South oppose the current power structures of global health, they must ‘lean in’ as the US ‘leans out’. While they cannot fill the void entirely, they may be able to occupy some of the vacated seats at the table.

The second issue is the risk of alternate state capture. Any nation willing to fill the funding void left by the US withdrawal could justify claiming significant influence at the tables previously dominated by the US. WHO must engage in careful and strategic negotiation to prevent one hegemon’s “leaning out” from enabling another to capture its place. The true goal is to diversify representation, and there is little to celebrate in simply replacing one dominant voice with another—from whatever geography they originate.

There is no joy in the US withdrawal from WHO. Working together, however, WHO and countries in the Global South could use this unsought “opportunity” to address structural flaws in the power distribution of global health. Ideally, other significant Global North countries working in global health will support these initiatives—or at least get out of the way. Following Wiyeh’s and Mukumbang’s suggestions, building leadership and technical capacity, amplifying diverse voices from the Global South, and prioritising equitable partnerships will not only strengthen WHO’s ability to adapt but also create a more inclusive and resilient global health system in the face of this challenge.