The feudal structure of global health and its implications for decolonisation
Global health as a field has its epistemological roots in related fields of tropical medicine and international health. These fields are not only products of colonialism, they also enabled imperialism through the destruction of traditional knowledge and consequent capture of the knowledge ecosystem. Efforts to decolonise global health are therefore much needed. Calls to reform global health institutions, global health education, agenda setting, resource allocation, the problem in ‘gaze’ and equitable institutional partnerships have been made. Unfortunately, diversity, equity and inclusion (DEI) remains a dominant framing of ongoing discussions on decolonising global health.
Efforts around DEI are indeed necessary—as a part of anti-racism and other social movements promoting inclusiveness of all forms of minorities in decision-making; but they do not effectively address the structural imbalance of power between high-income countries (HICs) and low/middle-income countries (LMICs). To undo the persistence of colonialism in global health, it is necessary to understand how feudal structures helped imperial forces to sustain political colonisation. In this editorial, we highlight the similarities of those feudal structures to the current global health ecosystem, and why DEI efforts alone may only strengthen this feudal structure. Moving forward, dismantling the feudal structure of global health should be a target for efforts to decolonise global health.
Keshri VR, Bhaumik S The feudal structure of global health and its implications for decolonisation BMJ Global Health 2022;7:e010603.