By Daniel D Reidpath & Pascale Allotey
Seye Abimbola and Madhukar Pai1 describe eloquently how, for historical reasons, global health is operationalised as a saviourism model. To redress the balance of power between saviour and saved, they envision a utopic global health fuelled by respect and humility, and motivated by an adherence to values based on rights, equity, and justice.
Unfortunately, the disciplines that dominate global health attend to the causes of and solutions to disease endpoints on the health and wellbeing spectrum. Such disciplines have not engaged adequately with a crucial understanding of the sociostructural production of health or with the political arguments based on myriad values that fall outside of the traditional medical and health sciences. It is impossible to decolonise global health if crucial geopolitical analyses, and the impact on relationships between high-income countries (HICs) and low-income and middle-income countries (LMICs), remain chronically marginalised.
Additionally, decolonising global health extends beyond relations between LMICs and HICs; it is also about the relationships within them. Decolonisation is fundamentally about redressing inequity and power imbalance. It cannot be achieved without also addressing gender inequity, racism, and other forms of structural violence. The colonised also have to be at least as reflective about the status quo as the colonisers. This mindset goes beyond engagement and participation between HICs and LMICs, to disrupting the norms of dependency within LMICs that enable the inequities and replicate the hierarchies of neocolonialism. In real terms, LMICs must confront their own internal power relations inherent in the discourse of immutable culture, which protect cronyism, tribalism, poor governance, and patriarchy.
Ultimately, a decolonised global health can only exist within a broader geopolitical and economic environment that supports rights, equity, and justice.