BMJ Global Health Commentary | Decolonising global health: if not now, when?

Ali Murad Büyüm, Cordelia Kenney, Andrea Koris, Laura Mkumba, Yadurshini Raveendran

Below is the introduction to this commentary.


The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak has grinded the world economy to a halt and upended health systems across the globe, contributing to disruptions in routine health services and skyrocketing rates of death.1 Against this backdrop, the pandemic highlights with renewed clarity the way structural violence operates both within and between countries. Defined as the discriminatory social arrangement that, when encoded into laws, policies and norms, unduly privileges some social groups while harming others, this concept broadens our thinking about drivers of disease.2 While the manifestation of inequity in each country or region is bound up in the local-to-global interface of historical, economical, social and political forces, COVID-19 disproportionately affects the world’s marginalised, from Black, Indigenous and People of Color (BIPOC) communities in North America to migrant workers in Singapore.3 Health outcomes related to SARS-CoV-2 infection such as access to emergency services and prolonged intensive care, capacity to prevent infection through non-medical countermeasures like handwashing and social distancing, and economic security while in lockdown are all mediated by the confluence of global, regional and local systems of oppression.

This reality shows that the current global health ecosystem is ill equipped to address structural violence as a determinant of health, and the system itself upholds the supremacy of the white saviour. As early career global health practitioners, we see this pandemic as an opportunity to critically appraise what is not working and to offer an alternative vision for the future of global health. Global health needs integrated, decolonised approaches—advanced by individuals and institutions—that address the complex interdependence between histories of imperialism with health, economic development, governance and human rights. The global movement to Decolonize Global Health, led by students and other professionals, is one step towards this vision.4–8 In this commentary, we draw on examples that show how the most vulnerable and marginalised in society are ignored and exploited by design and in context-specific ways in the pandemic response. Through these examples, we call for a threefold shift in global health research, policy and practice.