By Phuthumani Mlotshwa, Fiona A. Koeltringer, Carolina Garcia Sanchez, Christina Boger, and Giorgia Dalla Libera Marchiori at the Swedish Organization for Global Health
Over the past few years, there has been an increase in both awareness and call to action from students and early career professionals to decolonize the existing global health structures. This has stemmed from a generational realisation that the systems that created the current inequities in global health cannot be the same systems that solve them. More people have started to acknowledge that global health knowledge is dominated by an apparent “foreign gaze” that can easily be seen within the unequal power dynamics of “partnerships” between entities from high- and low-income countries. The increasing clamour on this issue, an example of which is MSF’s more vocal approach in dismantling systemic racism within their organisation, has been a good first step to slowly decolonize the global health system. However, this uproar can easily be drowned out if we are unable to craft more concrete, measurable and lasting solutions.
There is a consensus that the racial and ethnic discrimination that we are trying to confront in the marketplace have their roots in colonialism and white supremacy. These are social constructs that were allowed to permeate into society over a very long period, resulting in the many racially-driven consequences that different societies continue to face today even long after the world agreed to do away with most colonial practices. Examples of these consequences range from persons having the extreme viewpoint that some ethnicities are not considered human, to frequently encountering more subtle and socially acceptable biases seen on (social)media. Gaslighting comments, commercial ads perpetuating racial stereotypes, and the persistent promotion of skin whitening products, these are a few things that continuously place people of colour and other minorities in some form of a disadvantage. Regardless of the severity, the root comes from what has been implanted in people’s mindsets after experiencing so many years and forms of colonialism all around the world. Therefore, to dismantle such deeply rooted social constructs, it is important for those leading the decolonizing global health movements to understand how these ideas were first implanted in society and even our own mindsets.
So how did such a skewing social construct get so deeply embedded into the system of many societies? To answer this, we first need to dissect the process. Colonialism has mainly been characterised as imprinting the “superiority” of the coloniser’s ethnicity over that of the colonised. They make the latter feel and accept that their lives are on unequal ground and need the help of the former to live better—thus breeding the superiority and inferiority complexes that are commonly seen in modern society. These imprints, whether consciously or unconsciously, result in biases that breed all forms of racial discrimination—perpetuating inequity in all forms and situations, even in the professional global health field. As a result, when workers feel like they are belittled or discriminated because of their race or ethnicity, they are unable to contribute and work to their fullest potential; and the creation of a harmonious, motivated, and productive working space is impeded. And when this happens in the healthcare landscape and affects health service delivery, we can safely assume that the consequences are multiplied tenfold.
What makes it harder to eradicate such mindsets is that colonialism has been subsisted by the continuous distortion of information about the colonised—painting negative pictures of them—resulting in stereotypes that feed into discrimination. If we are to build on what the previous generations have done so far to weed out colonialism, society needs to intentionally create equitable imprints that are based on science rather than social constructs. Therefore, the accurate history of global health needs to be included in the teachings of global, public, international and planetary health. So, how exactly do we do this in the academic field?
- Exchange programmes in learning institutions should intentionally include content and activities that seek to undo misconceptions about other cultures.
- Course content should be continuously re-evaluated to weed out non-scientific conclusions that feed into stereotypes.
- Lastly, institutions must provide the students the time and the right tools to become active figures in the fight against discrimination in their future careers.
Global health organisations also play an essential role in creating new, non-colonial imprints on their members and the communities they operate in. As part of a growing body of smaller global and planetary health organisations, we believe it falls upon this generation of professionals to dismantle the internal castles and remnants of colonialism, piece by piece, until we achieve real equity. There is a need within global health organisations to create platforms that facilitate internal—albeit uncomfortable—conversations about racial discrimination and colonial aspects of their work.
- Dialogues on stereotyping and cultural differences should be pushed.
- Lived experiences of discrimination should be shared and addressed.
- Bringing to light the different historical narratives of countries they operate in must be encouraged.
- And training every person in the organisation to be aware of unconscious biases has to be regularised.
These are activities that can be done to promote an internal reflection and personal dismantling of preconceived discriminating constructs, whilst developing and giving younger generations the space to experience a world without them.
We at Swedish Organization for Global Health have slowly begun doing this in our own space. As a western organisation working in the “Global South”, routine internal discussions on post-colonial power imbalances in the global health landscape have resulted in a notable progress in levels of awareness and sensitivity among our members towards this issue. If the decolonizing global health movements are to achieve lasting strides in uprooting colonial remnants and remodelling equitable workspaces, then sizable effort will have to be made in decolonizing our own mindset, as global health professionals, first.
Declaration of interest
The authors declare no competing interests. We have not received any grant for this work from any funding agency in the public, commercial or not-for-profit sectors.
Acknowledgements
A huge thanks to all members of the Swedish Organization for Global Health who actively engaged in the uncomfortable conversations we had in the last year and a half around the colonial structure and history of global health. Also thank you to the advisory board for supporting these conversations and encouraging us to translate them into actions. All these human beings have contributed to the conversations that have informed our ‘decolonizing minds’ journey as an organisation, which has led to the submission of this commentary.
Authors contributions: Phuthumani Mlotshwa: Conceptualisation, writing – original draft, review & editing; Fiona A. Koeltringer: Conceptualisation, writing – original draft, review & editing; Carolina Garcia Sanchez: Conceptualisation, writing – review & editing; Christina Boger: Conceptualisation, writing – review & editing; Giorgia Dalla Libera Marchiori: Conceptualisation, writing – review & editing
Corresponding Author: Phuthumani Mlotshwa; 4 Gifford Ave, North End, Bulawayo, Zimbabwe; phuthumani.mlotshwa@ki.se; +263772211905
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