Undoing supremacy in global health will require more than decolonisation – Authors' reply
We thank Keerti Gedela as well as Pascale Allotey and Daniel Reidpath for their responses to our Perspective on decolonising global health. We welcome and completely agree with the points they highlighted for additional emphasis: greater focus on the local dynamics of how supremacy creates health (in)equity within countries, and expansion of our disciplinary focus to include research methods to understand how the geopolitics of supremacy creates health (in)equity between countries and to incorporate the knowledge held by the intended beneficiaries of global health efforts.
As we emphasised, colonialism and power asymmetry between high-income countries (HICs) and low-income and middle-income countries (LMICs) is but one manifestation of supremacy. Therefore, undoing supremacy will require much more than decolonisation. Nevertheless, decolonisation is a good place to start given its role in the creation of global health, and how coloniality persists in the field. The structures of supremacy and oppression that manifest between countries are reflected within countries in the supremacist institutions of, for example, class, racism, casteism, and patriarchy. Although the historical origins and underlying philosophy and rationale of these institutions might differ, they are similar in how they oppress and maintain inequities in (the circumstances that create) health. In addition to national spaces, oppressive power relations of supremacy are writ large in intranational spaces too. To understand how geopolitics perpetuate inequities and how incorporating local knowledge can help to reduce inequities in global health, we must undo another important supremacy in the field—ie, the disciplinary supremacy that places the quantitative biomedical and epidemiological sciences (often led by HICs) above the qualitative political and anthropological sciences.
One of the many great lessons of the COVID-19 pandemic is that achieving equity in (the circumstances that create) health is at least as much a domain of the political and anthropological sciences as it is one of the biomedical and epidemiological sciences. This lesson is relevant within HICs and LMICs, as it is in global and international affairs.Ultimately, as both Correspondences highlight, the locus of the change we seek in global health is within not only HICs but also LMICs. In research partnerships or funding decisions, it is not enough that HIC actors lean out. LMIC actors must also lean in—eg, by calling out parachute research, demanding reciprocity, setting up their own high-impact academic journals, or building high-quality schools of public health. However, doing so requires funding and political action, which national and international power relations might obstruct, but against which we must fight because combating all forms of supremacy should be synonymous with global health.
Seye Abimbola, Madhukar Pai, Undoing supremacy in global health will require more than decolonisation – Authors’ reply, The Lancet, Volume 397, Issue 10279, 2021