What are the major power asymmetries within Global Health, and how can we shift power to create more equitable, respectful and effective partnerships? How does coloniality manifest and perpetuate inequitable and exploitative relationships within Global Health, and what can be done to change this?

Power asymmetries between the various institutions, structures and actors that make up the global health system are common. Some of the relationships formed within the context of these power asymmetries are aptly labelled as colonial. These include relations between health actors (e.g. universities, NGOs and think tanks) in the Global North and their counterparts in the Global South, as well as between donors and their recipients in the Global South.

Past efforts to instill more equal partnerships include the International Health Partnership (IHP+) which aimed to apply the 2005 Paris Declaration of Aid Effectiveness to the field of health. Donors were encouraged to improve aid coordination; increase the predictability of donor aid flows; work towards strengthened country health systems; and renew commitment to mutual accountability and transparency. However, official development assistance is still frequently used as an instrument of foreign policy by donor countries, while global health financing instruments such as the Financial Intermediary Fund (FIF) for Pandemic Prevention, Preparedness and Response are still being designed in out-moded colonial terms. 

Coloniality within global health may also be expressed in more subtle ways. Within the global health academic complex, colonial relationships may be reflected in colonial authorship patterns and journals favouring authors from historically privileged universities; in unequal and exploitative research partnerships; or in the use of narratives and epistemological hierarchies that perpetuate social and colonial hierarchies.  

The deployment of knowledge and knowledge systems to sustain and reinforce social hierarchies manifests in many ways. They include the deliberate framing of global health problems and inequalities as apolitical and technocratic challenges, as well as in the marginalisation and diminution of knowledge systems, held by many colonised indigenous peoples, that are crucial if we are to effectively deal with the ecological crisis facing modern human civilisation.