A Paradigm Shift for Decolonizing Global Health

Defining Global Health

Global health is an interdisciplinary field that prioritizes improving health and achieving equity for all people worldwide. It encompasses transnational health issues, determinants, and solutions and involves interdisciplinary collaboration across the health sciences and beyond. As described by Koplan et al. (2009), global health is both population-based and individual-focused, ethically oriented, and guided by principles of justice. Despite these aspirations, global health remains vague and versatile, shaped by diverse historical antecedents and contemporary realities. Its governance often reflects political decision-making processes influenced by power structures that perpetuate inequities.

Who Is a Global Health Expert and Who Is Not?

Defining a global health expert is fraught with challenges. Expertise in global health extends beyond academic credentials and technical skills; it requires contextual understanding, cultural competence, and intellectual humility. An expert must grasp the interconnected social, cultural, political, and economic factors influencing health globally.

Conversely, individuals who lack contextual understanding or approach global health with a savior complex fail to qualify as true experts. One-dimensional expertise confined to a single country or discipline, or short-term, superficial engagement in global health without critical ethical reflection, undermines the integrity of the field. Global health must reject paternalistic mindsets that impose external solutions without local input.

The Need to Decolonize Global Health

Global health has been shaped by colonial legacies that reinforce power imbalances, perpetuate epistemic violence, and marginalize local knowledge systems. Institutions in high-income countries (HICs) dominate funding, research, and leadership, sidelining voices from the Global South. This inequity manifests in research agendas dictated by Global North priorities, “helicopter research,” and tokenistic representation.

The urgency to decolonize global health stems from these persistent inequities. As Madhukar Pai argues, global health risks perpetuating the very inequities it seeks to address unless power imbalances are tackled. Decolonizing global health involves dismantling systems that perpetuate injustice and building equitable partnerships grounded in mutual respect and shared decision-making.

How to Effectively Decolonize Global Health

Redistributing Power and Resources

Shifting decision-making authority, funding, and leadership to local experts and institutions in low- and middle-income countries (LMICs) is essential. This includes rethinking funding mechanisms to prioritize local leadership and equitable partnerships.

Revising Curricula and Narratives

Global health education must embrace diverse perspectives, including contributions from LMICs and Indigenous knowledge systems. This requires updating curricula to challenge Northern-centric frameworks and highlight the voices of Global South experts.

Promoting Equitable Partnerships

True partnerships must emphasize shared ownership of research and program outcomes. Collaborative models should prioritize sustainability, capacity building, and community engagement.

Addressing Language and Representation

The dominance of the English language in global health marginalizes non-English speakers and limits participation. Encouraging multilingual communication and dismantling linguistic barriers can promote inclusivity and respect for diverse knowledge systems.

Centering Indigenous and Local Knowledge

Recognizing and validating Indigenous and local knowledge systems is vital. This includes redefining research processes to shift power to local communities and fostering epistemological plurality.

Challenging Structural Inequities

Advocating for systemic changes in global health governance—including fair representation in decision-making bodies—is crucial. Efforts should address the root causes of inequities, such as funding dynamics and institutional biases.

Challenges in Decolonizing Global Health

Tokenism and Symbolism

Without structural changes, decolonization risks being reduced to performative gestures. Tokenistic representation in leadership roles, for instance, often fails to translate into real decision-making power.

Co-optation by Power Structures

The movement risks appropriation by Global North elites, who may dilute its transformative potential to serve their interests.

Ambiguities and Fragmentation

A lack of clear frameworks for operationalizing decolonization can lead to fragmented efforts and conflicting interpretations.

Exclusion of Local Voices

Without authentic community-led processes, the movement risks reinforcing existing hierarchies and marginalizing the voices it aims to elevate.

Failure to Address Root Causes

Focusing on surface-level changes without confronting deeper structural issues—such as inequitable funding dynamics—undermines the movement’s credibility.

Limitations of the Current Decolonization Movement

Despite increased awareness, the current decolonization movement often fails to achieve its goals due to superficial engagement. Northern control of funding and the exclusion of local knowledge systems persist. Additionally, the biomedical dominance in global health marginalizes social sciences and interdisciplinary approaches.

Publications on decolonization disproportionately feature authors from Global North institutions, even when addressing Global South issues. This highlights ongoing epistemic exclusion and the marginalization of local knowledge. Without addressing these limitations, the movement risks losing its transformative potential.

How to Make Decolonization More Meaningful

Fostering Inclusive Frameworks

Develop actionable frameworks rooted in local realities and community-led participatory methods. Amplify voices from the Global South in research and policy-making.

Promoting Intersectionality and Hybrid Approaches

Move beyond binary narratives to embrace intersectional and hybrid approaches that reflect the complexities of global health challenges.

Building a Critical Mass of Courageous Scholars

Encourage interdisciplinary collaboration and train scholars to navigate the ethical and political dimensions of global health. Recognize the importance of intellectual humility and cultural competence.

Ensuring Accountability and Equity

Use tools like the Equity Tool (EQT) to monitor and measure equity in global health partnerships. Emphasize trust, transparency, and shared decision-making.

Adopting Ubuntu Principles

Ubuntu’s philosophy—“I am because we are”—promotes solidarity, mutual respect, and co-learning between professionals from the Global North and Global South. This collective approach centers on the diverse populations it serves.

Conclusion

Decolonizing global health requires a paradigm shift that dismantles inequitable systems, amplifies marginalized voices, and embraces epistemological plurality. By addressing power imbalances, revising narratives, and fostering equitable partnerships, the movement can achieve its transformative potential. True decolonization must integrate local knowledge, multilingual practices, and continuous reflection to foster justice, inclusion, and equitable collaboration. Only through intentional and courageous efforts can global health advance as a field that genuinely prioritizes equity and justice.