Prof. Agnes Binagwaho

The term “decolonization” has been increasingly used to refer to the elimination of the colonial experience and its legacy. However, the use of this overarching term masks the real root of the problem. European countries, whose populations are majority white, used their assumed supremacy as justification for the colonization of current low- and middle-income countries (LMICs) where the majority of non-white people live. This clear overlap between geographic and skin color differences explains how the white supremacy ideology triggered European colonization. Therefore, calls to decolonize global health education must focus on the roots of colonization and fight for the elimination of white supremacy ideology that is one of the pillars of the current ills of our global health architecture. A step in this process acknowledging the expertise that emerges from LMICs, alongside challenging the traditional high-income country (HIC) hegemony over knowledge and strengthening universities in LMICs to provide quality medical and global health education. Additionally, we also need to reevaluate curricula, research selection, and design as well as partnerships. Students need to be equipped with the skills to question norms and contribute to the creation of equitable, mutually beneficial partnerships. This needs to accompanied by the adoption of transdisciplinary education to address critical societal challenges. By challenging the white supremacy ideology, we can shift the center of gravity in global health to respect the right to equal say in education and research according to the disease burden and the distribution of the world population.

The growing awareness of colonialism’s role in global health partnerships between HICs and LMICs and the associated calls for decolonization in global health has led to discussion for a paradigm shift that would lead to new ways of engagement and partnerships, as well as an acknowledgement that colonialism, racism, sexism, and capitalism contribute to inequity. While there is general agreement among those involved in global health partnerships that the current system needs to be made more equitable, suggestions for how to address the issue of decolonization vary greatly, and moving from rhetoric to reform is complicated. Based on a comprehensive (but not exhaustive) review of the literature, there are several recurring themes that should be addressed in order for the inequities in the current system to be changed. The degree to which decolonization of global health will be successful depends on how the global health community in both the HICs and LMICs move forward to discuss these issues. Specifically, as part of a paradigm shift, attention needs to be paid to creating a more equal and equitable representation of researchers in LMICs in decision-making, leadership roles, authorship, and funding allocations. There needs to be agreement in defining basic principles of best practices for global partnership, including a universal definition of ‘decolonization of global health’; the extent to which current policies allow the perpetuation of power imbalance between HICs and LMICs; a set of principles, best practices, and models for equitable sharing of funds and institutional costs among partners; a mechanism to monitor progress prospectively the equitable sharing of credits (e.g., leadership, authorship), including a set of principles, best practices, and models; and, a mechanism to monitor progress prospectively the extent to which decolonialization will contribute to strengthening institutional capacity in the LMIC institutions.