A growing movement to decolonise global health has gained momentum as the world grapples with ongoing health crises, from COVID-19 to climate change-induced disasters. This call for transformation challenges us to critically examine the power structures, assumptions and practices that have long defined the field.

Decolonising global health aims to dismantle the colonial legacies that continue to shape health research, policy and practice worldwide. As Kwete et al. argue, “the current status quo of global health is still replete with various forms of colonial vestiges–ideologies and practices”. These vestiges manifest at multiple levels, from individual interactions to institutional structures to overarching paradigms.

One of the most visible symptoms is the persistent marginalisation of voices from the Global South in leadership, decision-making and knowledge production. Despite rhetoric about equity and partnership, global health remains dominated by institutions and individuals from high-income countries. As one analysis found, over 80% of global health research on Africa has no African authors.

This imbalance reflects deeper issues of power and positionality. As Badham notes, “Voices from the ‘Global South’ are often marginalised because their abilities” are undervalued or overlooked. Addressing this requires more than simply increasing diversity — it demands a fundamental shift in how we conceptualise expertise and authority in global health.

The legacy of colonialism is deeply embedded in the structures and practices of global health. As Peace Direct’s recent report on decolonising aid argues, “Many current practices and attitudes in the aid system mirror and are derived from the colonial-era, which most organisations and donors in the Global North are still reluctant to acknowledge.”

This reluctance to engage with the colonial roots of global health work undermines efforts to address ongoing inequities. Certain modern-day practices reinforce colonial dynamics, from the ‘White saviour’ ideology visible in fundraising imagery to the organisational structures of INGOs in the Global South.

Language and framing also play a crucial role in perpetuating colonial mindsets. Terms like “Global South” and “developing countries” reinforce notions of Western superiority and a linear path of “progress” defined by the West. Even well-intentioned efforts at “capacity building” can imply deficiency. As global health practitioners and researchers, we must critically examine our words and their implicit assumptions.

At an institutional level, the flow of funding, priorities and accountability in global health often mirror colonial relationships. Major funders and international organisations remain concentrated in high-income countries, with limited representation from the communities they purport to serve. This setup can lead to misaligned priorities and interventions that fail to address local needs and realities.

Peace Direct’s consultation found that only 12% of international grant dollars from US foundations go directly to organisations based in the country where programmes are implemented. This means that everything from who controls the disbursement of funds to who defines a project’s success is rooted in the values and beliefs of the Global North.

Transforming these entrenched systems requires more than superficial changes. As Kwete et al. argue, “to fully decolonise global health, systemic reforms must be taken that target the fundamental assumptions of global health”. This includes questioning core premises about the relationship between health and development.

A crucial first step is to acknowledge that structural racism exists within global health institutions and practices. Many organisations still need to engage with this uncomfortable reality. Yet, as Peace Direct’s report argues, “If policymakers, donors, practitioners, academics and activists do not begin to address structural racism and what it means to decolonise aid, the system may never be able to transform itself in ways that truly shift power and resources to local actors.”

This shift requires ceding control and embracing uncertainty. For donors and international NGOs, funding “courageously” means creating more accessible and flexible funding pathways and prioritising local leadership. It means relinquishing the insistence on rigid metrics and acknowledging that transformative change is inherently messy.

For global health education, decolonisation demands expanding curricula beyond Western perspectives to centre diverse scholars, epistemologies and historical analyses. It requires opportunities for students and practitioners from the global North to critically examine their power and positionality.

Decolonising global health does not mean rejecting all Western contributions to the field. Instead, it calls for a more inclusive, equitable approach that values diverse forms of knowledge and experience. As Garba and colleagues argue, the goal is to “create a more just and equitable global health landscape”.

Yet we must also grapple with more radical critiques that question whether global health — given its colonial origins — can ever be decolonised. Some scholars argue for new paradigms centring on solidarity and cognitive justice principles.

Decolonising global health is not a finite destination but an ongoing critical reflection and action process. It demands that we continually examine our assumptions, practices and impacts. As global health practitioners, researchers and advocates, we must ask ourselves: Whose voices are we centring? Whose knowledge are we valuing? And whose interests are indeed being served by our work?

By honestly confronting these questions, we can build a more equitable and genuinely global approach to health. This transformation will take work. Entrenched power structures and vested interests will inevitably resist change.

Yet the stakes could not be higher. As converging crises of pandemic disease, climate change, and widespread inequity threaten health worldwide, we desperately need new approaches that centre the knowledge and leadership of communities on the frontlines.

Decolonising global health ultimately means “moving the centre”, as Ngũgĩ wa Thiong’o reminds us. It requires shifting power, resources and decision-making to those most impacted by health inequities. Only then can we hope to realise the field’s lofty health aspirations.

References:

Kwete, X. et al. (2022). Decolonizing global health: what should be the target of this movement, and where does it lead us? BMC Global Health Research and Policy, 7(1), 1–6.

Peace Direct. (2021). Time to Decolonise Aid: Insights and lessons from a global consultation. London: Peace Direct.

Garba, D. L., Stankey, M. C., Jayaram, A., & Hedt-Gauthier, B. L. (2021). How do we decolonize global health in medical education? Annals of Global Health, 87(1).