By Harvy Joy Liwanag and Emma Rhule
The COVID-19 pandemic has shone a spotlight on existing systemic inequities, both in terms of health inequity and broader socio-economic inequities.1 There have been calls globally not just to build back better but to do so in a way that dismantles structural inequities.2 Abimbola et al3 have outlined facets of supremacy, encompassing coloniality, patriarchy, racism, white supremacy and saviourism, that together maintain power asymmetries and privilege within global health. The push-back against these inequities is perhaps most visible in the many calls to ‘decolonise global health’.4–7 While there is currently no unified definition of what it would mean to decolonise global health, in its broadest sense it has been described as the ‘imperative of problematising coloniality’.8 Over the past 18 months, ‘decolonising global health’ has gained pace as a collection of activist movements that seek to transition from the theoretical to the practical. While differing in approach9–11 they are unified by the impetus to actively deconstruct ingrained systems of power and privilege that continue to prioritise the perspectives of those from former colonial powers, persistently marginalising those with lived experience and hampering the attainment of health equity.
In the clamour for change and with the increasing political prioritisation of the decolonising agenda, there is a real risk of individuals and institutions entering the discourse in ways that are performative.12 13 Actions may be motivated by their perceived ability to further the careers of individuals, bolster the reputations of institutions or simply by a desire to be seen to be ‘doing something’. Reflexivity, the act of acknowledging individual positionality14 15 and motivation16 when engaging with the rhetoric on systems transformation,17 has been posited as a vital component of decolonising global health and in dismantling supremacy more broadly.
Our route to developing a reflexive process was sparked by conversations within and outside our institute on the prevalence of the foreign gaze and lingering colonial legacy in global health. It was also prompted, in part, by a question from a fellow low-to-middle-income country (LMIC) participant during a session on COVID-19 in a global health conference:
‘As LMICs are not capable [emphasis ours] of utilising the evidence for policy decision-making, though they have an ample of evidence within their system, shall the WHO facilitate collaboration between LMICs and developed countries for evidence-based decision-making?’
The question was likely raised with an intent to improve the pandemic response in LMICs, but its phrasing struck a chord. The perception that LMICs need to be ‘rescued’ by high-income countries (HICs) still lingers even though many LMICs have performed well in managing the pandemic.18
The question has led us to discuss the persistence of colonial mentality, or the automatic preference, expressed either consciously or subconsciously, for anything Western.19 We cannot transform global health while people’s views of what global health is remain unexamined and unchanged. For global health transformation to become more than just an academic discussion, the discourse must be relatable and made personal through reflexive dialogues between individuals across geographical, economical and epistemic divides. However, without clarity on what reflexivity concretely requires, calls to be reflexive run the risk of becoming lip service. Reflexivity cannot transform global health when it is only self-reflection or does not lead to collective action.