Introduction to decolonizing global health: the role of students

By Alina Rachiteanu, GlobeLife Student Section

“If we are going to interfere in the life of others, a little due diligence is a minimum requirement” wrote Nigerian-American writer Teju Cole in 2009. As public and global health students, how can we get involved in promoting due diligence in our line of work and daily life? Here, I summarize some of the considerations presented during a seminar on decolonizing global health.

On the 15th of November 2022, the student-led organizations Decolonizing Global Health Sweden chapter at Karolinska Institute and the GlobeLife student section hosted a Zoom seminar titled “Introduction to Decolonizing Global Health”. The speaker, Dr. Aloysius Ssennyonjo, a medical doctor and public health expert from Makerere University in Kampala, Uganda, provided key insights into the history of the Decolonizing Global Health (DGH) movement and some considerations on how students from both the Global South and Global North can be engaged in it.

Before diving into the topics covered during the seminar, I would like to clarify that throughout the following paragraphs, I will be using Global South to identify countries in Central and South America, Africa and Southern Asia, and Global North for North America, Europe, Australia, New Zealand, and Japan. I will use these denominations in line with how terminology was used during the seminar. In addition, I will use the World Bank classification of countries based on income.

I also find it necessary to define my positionality as a white European global health master’s student in Sweden, a high-income country, and, as such, acknowledge my privilege. This article represents my understanding of the seminar and some of my thoughts that have matured during my ongoing learning – and unlearning – of this topic.

Dr. Ssennyonjo’s talk started with historical references to the colonial past of Africa, its legacies, and the growing DGH movement. He highlighted the importance of history in the current state of the world. Being almost fully previously colonized by European countries, the African continent is still heavily impacted by colonial legacies across the economic, political, and social spheres. Long-term effects of colonialism include foreign-oriented and dependent economies as opposed to pre-colonial self-reliant ones, weak political entities due to in-country fragmentation, and an uneven development within the colonized countries. Along with colonial legacies, a similar but more indirect form of colonialism, namely neo-colonialism, inevitably impacts formerly-colonized countries and determines power dynamics. Neo-colonial governance operates through financial investments, including economic aid, which keep lower-income countries in a situation of dependency, while serving as a reservoir of cheap labour and raw materials for the world’s powers.

Grayscale image of a protest on a street.
Colonial legacies and neo-colonialism have created economic, political and social instability. Photo by Pawel Janiak on Unsplash.

These phenomena intersect with global health and research, resulting in imbalances and inequities between the Global North and the Global South. They manifest as uncritical faith in the expertise and technology of the Global North, the concentration of resources in high-income countries, and one-way information flows, among others.

The session continued with a picture of the state of affairs in global health education and research. The great majority of global health programs are located in high-income countries and often come at a high price, with expensive tuition fees for international students and high living costs. This would potentially prevent trainees from lower-income countries from attending such programs without financial aid. Moreover, curricula still overlook the colonial roots of global health and topics such as racism, allyship, and decoloniality. While efforts to decolonize education and research are taking place, these need to include not only changes in the education system but also a reevaluation of the underlying beliefs, attitudes, and assumptions.

Imperialism leaves behind germs of rot which we must clinically detect and remove from our land but from our minds as well.

Frantz fanon

During the session, Dr. Ssennyonjo invited the audience to reflect on some important questions: from whose perspective is global health branded? Is a researcher from the Global South also a global health expert? Does a short trip or gap year in the Global South confer global health expertise? These questions challenge the basis on which global health was built and encourage us to view this discipline from the perspective of students and professionals from the Global South.

How can we, as students in this field, become involved in the decolonization of global health? Dr. Ssennyonjo emphasises the importance of working on oneself by being aware of one’s own biases and confronting them. Overcoming prejudices about others and the unknown facilitates intercultural exchanges and more fruitful and meaningful learning experiences. The example of students travelling to other countries to study was brought up, as they might tend to surround themselves with people of the same nationality and see only the negative aspects of the new country. Instead, students should be around different people, engage in student affairs, and advocate for what they believe in. Students from lower-income countries, in particular, are encouraged to get their voices heard and share their experiences to ultimately change the way global health is taught.

A group of people, seemingly students, sitting at a table with highlighters and epns
Engaging in student activities and advocating is how we can do our part as students. Photo by StockSnap on Pixabay.

In view of our future as global health professionals, the introspective work needed to decolonize global health has to start now by learning from history, challenging our motives and dismantling and reconsidering our attitudes and assumptions. Is wanting to “make a difference” enough to get involved in the lives of others? Are we doing more good than bad by getting involved? These are the questions, among others, that I think we should consider as students, future practitioners, and members of society if we hope to change how global health is practised.

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