More information about text formats
Svadzian et al.  noted that most universities in high-income countries (HICs) demand higher tuition fees from low- and middle-income country (LMIC) students for masters-level global health degrees – a problem potentially further exacerbated by COVID-19, with many HIC universities increasing international tuition fees to make up a resultant funding deficit.  While the paper only focuses on masters-level global health degrees, it should be noted that some HIC universities, such as York University in Toronto, have long-standing undergraduate-level global health degree programs. Taking significantly longer to complete than masters degrees, these problems are felt to a greater extent for LMIC students who want to study global health as their first degree.
The fundamental premise in their paper is that if HIC universities were serious about equity then they would be offering lower tuition fees (and scholarships to support living/travel costs) to students from LMICs. This presumes that merely lowering tuition or offering more scholarships would eliminate the primary access barrier for LMIC students, especially those from less privileged backgrounds. Unfortunately, this is sadly not the case. Even students with tuition waivers/scholarships can have difficulty obtaining visas to study at HIC universities.
Student visas are a regressive tax on LMIC  – the requirements to obtain numerous documents that require certification, additional fee payments to an HIC-af...
Student visas are a regressive tax on LMIC  – the requirements to obtain numerous documents that require certification, additional fee payments to an HIC-affiliated third party months in advance, embassies can hold passports for long periods, with applicants needing to satisfy vague criteria that can allow visa officials to arbitrarily deny applications. Furthermore, LMIC students often have to apply multiple times (paying new fees each time) to obtain a visa – which can be denied – thereby leaving students dejected having to delay or abandon their education abroad.
LMIC students have particular issues satisfying visa criteria around financial sufficiency, intent of return to home country (including family ties), and lack of job prospects in home country.  These criteria are often subjectively adjudicated by immigration officers with arbitrary results – e.g., anecdotal reports of LMIC students with full scholarships being rejected on the basis of financial insufficiency. Thus, merely offering LMIC students visa support/advice is not sufficient. Change is required in immigration policy and practice in HICs, particularly in Canada, UK, and the USA , to ensure LMIC students wanting to study global health can gain entry.
There are also important regional differences in how this is experienced across LMICs, with African students being more likely to be refused visas. [5, 6] Students from Asian LMICs (e.g., China, Japan, India) tend to have the easiest time at getting student visa to study in HICs – which results in HIC universities tending to concentrate their recruitment efforts in these countries, further entrenching educational inequities among LMICs.
Achieving equity in global health education will be ultimately secured as it will be in global health practice – by adequately addressing the underlying structural conditions/drivers. While everyone should support lower tuition fees and increased scholarship support for LMIC students, without a fundamental change to the current discriminatory approach to visa issuance, we will not be able to achieve equity in global health education.
1. Svadzian A, Vasquez NA, Abimbola S, et al. Global health degrees: at what cost? BMJ Glob Health 2020;5(8) doi: 10.1136/bmjgh-2020-003310 [published Online First: 2020/08/08]
2. DePietro A. Impact Of Coronavirus (COVID-19) On College Tuition And Finances. Forbes June 2, 2020. https://www.forbes.com/sites/andrewdepietro/2020/06/02/impact-covid-19-t... (accessed August 12, 2020).
3. George A, de Jong M. Visas: a regressive tax on LMICs. Health Systems Global October 9, 2019. https://healthsystemsglobal.org/news/visas-a-regressive-tax-on-lmics/ (accessed August 12, 2020).
4. Immigration Refugees and Citizenship Canada (IRCC). Open Data Portal. https://open.canada.ca/data/en/dataset?_organization_limit=0&organizatio... (accessed August 12, 2020).
5. The Lancet Global Health. Passports and privilege: access denied. Lancet Glob Health 2019;7(9):e1147. doi: 10.1016/S2214-109X(19)30337-7 [published Online First: 2019/08/14]
6. Toughill K. Four in 10 international students turned away by Canadian immigration. Polestar Immigration Research September 4, 2019. https://studentimmigration.ca/four-in-10-international-students-turned-a... (accessed August 12, 2020).