Decolonising Global Health

Lachy Faktor

25/3/22

Global Health, in its current era, strives for equity and justice. Many of these goals are essentially trying to undo the damage that colonialism brought to countries throughout Africa, South America and South East Asia, as well as the indigenous populations of Australia, New Zealand and the United States (just to name a few). I would argue that the Oxford definition of colonisation – The action of appropriating a place or domain for one’s own use. Often related to settling among and establishing control over the indigenous population of an area – does not encapsulate the full scope of what happens. Even after colonisers have left the land, countries still feel the terrible effects, some of which arose as a direct result of ‘decolonisation’

I argue that decolonisation is more than just the exiting of a territory previously occupied by a colonial force; this makes it seem like the decolonisation process is complete. The truth is that we are far from completion. Decolonisation is an ongoing process, and requires a complete rejection of colonial traditions and thought patterns which are still prevalent in high income countries. 

It is subconscious colonial attitudes that see previously colonised countries as “third world”. This feeds into the idea that these countries are somehow substandard to high income countries, and that previously colonised countries are incapable of solving their own problems. It is a similar way of thinking that fuels rampant racism against First Nations Australians. This same attitude sees shoddy, self serving, culturally unsafe, philanthropic misadventures constantly bombarding low resource nations. So born is the ‘voluntourism’ movement, leading to children being treated as tourist attractions and being forcibly or coercively separated from their families to be placed in orphanages. In a similar vein are medical students flying overseas and playing doctor. Medical students would never be allowed to act independently, without oversight, nor make clinical decisions for patients here in Australia. So why should people in low resource nations be subjected to a standard of care that we deem inappropriate? This is structural violence that is a remnant of colonial attitudes still held by us in high income countries.

There are still many mechanisms that embody colonial ideas: funding which build infrastructure that further increases the reliance of low resource countries on donors; grants and job opportunities which take the brightest, up-and-coming minds from their home countries and pull them into corporations in high income countries; organisations that deliver healthcare to populations in a way that makes them further reliant on external help; and structural violence against First Nations Australians in governmental policy.

An equally large issue is the influence of high income countries on global organisations such as the International Monetary Fund and the World Bank. While the United Nations and the World Health Organisation have equal voting rights, this is not the case in the International Monetary Fund and the World Bank. Arguably, these two are more powerful players than the WHO and UN, yet there is much less representation from low resource nations, who these organisations are supposed to benefit.

So how do we fix this?

The answer is: we don’t. 

That is to say, we in high income countries cannot fix something we know nothing about. Trying to act like “saviours” and fix the world’s problems simply continues the oppressions of colonialism – pushing our views of success on those who did not ask for it. This doesn’t mean we walk away and ignore the health challenges that previously colonised nations and populations are facing. It means we hand over the reins to the people with lived experience of their country’s health challenges, who have an in-depth knowledge of their country’s peoples and culture, and who can devise sustainable and culturally appropriate solutions. Our role is to listen to previously colonised countries and populations, and assist in areas in which they want our help. 

High income nations need to relinquish control of the World Bank and International Monetary Fund, and give control of the funds to the countries being “helped” by these groups. We need to support research led by nations and populations that were previously colonised and initiatives borne out of this research. 

This is already happening. Community-led research projects are starting to undo some of the colonial damage suffered by previously colonised nations. Projects that survey the beliefs and wants of the community, then implement the solutions in an independent and community-driven way, are strengthening and rebuilding the health of previously colonised nations. First Nations Australians are taking charge of their own health through National Aboriginal Controlled Community Health Organisations (NACCHO), and slowly healing.

The global health movement needs to continue to strive for equity and justice, but needs to add in an additional ethical principle: autonomy. Previously colonised countries and indigenous populations need their autonomy back to fully shake off the hand of colonialism. Until this is done, we will never truly have global health, globally. 

Much of the content of this article drew inspiration from Associate Professor Maithri Goonetilleke’s lectures, as well as an article by Kwete and colleagues.

The author would like to acknowledge the traditional owners of the land this article was written on; the lands of the Wurundjeri people of the Kulin Nations, and pay respects to elders past, present and emerging. Sovereignty was never ceded; always was, always will be. 

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