Decolonising global health in 2021: a roadmap to move from rhetoric to reform

TLDR

Decolonising global health, a movement critiquing colonial legacies and power imbalances in health work, dominated 2020 discourse with over 50 academic articles, conferences, and leadership statements, highlighting the need to shift from rhetoric to concrete reforms. The authors propose a practical roadmap for global health practitioners to transform rhetoric into reforms by implementing systemic changes in high‑income‑country led organisations. Drawing on the collective experiences of diverse practitioners, the roadmap identifies institutional processes that perpetuate power imbalances and outlines actionable changes.

Abstract

Decolonising global health was a hot topic in 2020. It was the subject of more than 50 academic articles between January and December 2020, appeared as a new area covered in numerous conferences, and featured in public statements by leaders of global health organisations. Although its aims have not been formally defined, we see ‘decolonising global health’ as a movement that fights against ingrained systems of dominance and power in the work to improve the health of populations, whether this occurs between countries, including between previously colonising and plundered nations, and within countries, for example the privileging of what Connell calls research-based knowledge formation over the lived experience of people themselves.1 2 It is well documented—although often overlooked—that global health has evolved from colonial and tropical medicine, which were ‘designed to control colonised populations and make political and economic exploitation by European and North American powers easier’.3 The operations of many organisations active in global health thus perpetuate the very power imbalances they claim to rectify, through colonial and extractive attitudes, and policies and practices that concentrate resources, expertise, data and branding within high-income country (HIC) institutions.4 5 As a group of global health practitioners from different backgrounds, we reflect on our personal and professional experiences of systems and processes that institutionalise power imbalances. In this article, we propose a roadmap for global health practitioners, like us, who want to see rhetoric turn into reforms, focusing on systemic changes needed in organisations led from HICs. This is important now, because the flurry of statements and virtue signalling in 2020, could, in …