Barriers to Decolonizing Global Health: Identification of Research Challenges Facing Investigators Residing in Low- and Middle-Income Countries

The field of global health aims to leverage global partnerships to investigate issues transcending local boundaries. It acknowledges the importance of forming collaborative teams with diverse knowledge and experience to combat health disparities. However, in practice, global health is dominated by high-income countries (HICs). Most global health centers, global health conferences, and corresponding authors in global health journals are located in HICs. Though income is an imperfect classifier of countries, the dominance of HICs hints at the colonial legacy plaguing global health.

Global health’s colonial legacy stems partly from the concept of “tropical medicine,” which was born from the necessity to understand diseases in areas of the world occupied by European colonial powers with economic, political, or military agendas. Today, global health remains plagued by power structures based upon colonial legacies of inequity and agendas mired in priorities set by HICs. These structures and agendas drive HICs to engage within low- and middle-income country (LMIC) health systems without prioritizing partnerships with LMIC investigators.This practice threatens the global health promise of equity and justice and decreases the LMIC relevance and, thus, the quality of global health projects.

There are mounting efforts to decolonize global health and work toward a future where investigators from LMICs and HICs engage in equitable partnerships. To that end, the University of Washington developed a Decolonizing Global Health Toolkit to help research teams acknowledge and dismantle power dynamics rooted in colonial legacies. The toolkit guides teams in assessing power structures using the Decolonization Power Structure Assessment Framework before and during study implementation, The framework calls for researchers to (1) identify project roles, (2) describe existing power dynamics, (3) explore barriers to equitable partnership, and (4) take action to overcome the barriers.

Nana Anyimadua Anane-Binfoh, Katelyn E. Flaherty, Ahmed N. Zakariah, Eric J. Nelson, Torben K. Becker and Taiba Jibril Afaa, Global Health: Science and Practice February 2024, 12(1):e2300269; https://doi.org/10.9745/GHSP-D-23-00269