Dialogical reflexivity towards collective action to transform global health

The COVID-19 pandemic has shone a spotlight on existing systemic inequities, both in terms of health inequity and broader socio-economic inequities.1 There have been calls globally not just to build back better but to do so in a way that dismantles structural inequities. Abimbola et al have outlined facets of supremacy, encompassing coloniality, patriarchy, racism, white supremacy and saviourism, that together maintain power asymmetries and privilege within global health. The push-back against these inequities is perhaps most visible in the many calls to ‘decolonise global health’. While there is currently no unified definition of what it would mean to decolonise global health, in its broadest sense it has been described as the ‘imperative of problematising coloniality’. Over the past 18 months, ‘decolonising global health’ has gained pace as a collection of activist movements that seek to transition from the theoretical to the practical. While differing in approach they are unified by the impetus to actively deconstruct ingrained systems of power and privilege that continue to prioritise the perspectives of those from former colonial powers, persistently marginalising those with lived experience and hampering the attainment of health equity.

In the clamour for change and with the increasing political prioritisation of the decolonising agenda, there is a real risk of individuals and institutions entering the discourse in ways that are performative. Actions may be motivated by their perceived ability to further the careers of individuals, bolster the reputations of institutions or simply by a desire to be seen to be ‘doing something’. Reflexivity, the act of acknowledging individual positionality and motivation when engaging with the rhetoric on systems transformation, has been posited as a vital component of decolonising global health and in dismantling supremacy more broadly.

Summary

Decolonising global health has gained momentum in recent years and has called for more reflexive individuals.

However, the call to be reflexive may run the risk of becoming lip service without clarity on what reflexivity requires.

We diverge from reflexivity’s usual place in qualitative research, bring it closer to individual positionalities and frame it as comprising of: (a) self-understanding; (b) dialogue with peers; and (c) insights-to-action.

We argue that reflexivity that is either in isolation or without action will not contribute to global health transformation.

We present insights and action points from our journeys in global health to demonstrate examples of what may emerge from dialogical reflexivity as we have framed it here.

We call on peers to build a culture of reflexivity by sparking dialogues in their institutions and translating their insights into collective action.

Liwanag HJ, Rhule E, Dialogical reflexivity towards collective action to transform global health BMJ Global Health 2021;6:e006825.