Why it's important for future healthcare professionals to understand 'decolonizing' Global Health, and how this can be done
Nardin Farag, MD candidate at McGill University
What is now known as Global Health has emerged from International Health, Tropical Medicine, and Colonial Medicine, all of which were created to look after the (western) Man, by placing him as the center of priorities in the Global Health agenda (1). While we have dismantled colonial administrations, we can still see a colonial pattern in the agency of Global Health (i.e. the patterns of power that control economy, culture, knowledge production, body and psyche, and authority) (2). For example, psychiatrist Derek Summerfield explains how “white western psychiatrists” impose diagnoses which ignore local understandings of distress, thus emphasizing how the mental health industry is a perpetrator of dominion and power (3). He concludes by questioning why anthropology is not an important topic when it comes to global mental health, without having a preformed meaning of mental health outside of the western world (3). Moreover, input from experts that are from high-income countries (HICs) is more valued than those from low- or middle-income countries (LMICs) (4). By working towards decolonizing Global Health, we need to understand the structures of power that lead to the flow of knowledge and funding to be unidirectional (4). Over the decades, we have been left with legacies that result in dehumanization and othering, which are still widely present in Global Health (2). Some examples include our racial biases and assumptions that affect pain management of Black people, and characterizing Africa as a disease-ridden continent (2). The importance of the topic of ‘decolonization’ in Global Health challenges the current depoliticized and ahistorical approach to teaching GH(5).
Therefore, the problem with Global Health nowadays, and why we need to rethink Global Health education, is that we focus so much on the health inequities and inequalities, such as how social determinants of health lead to health disparities. However, we should also understand the root cause (i.e. colonialism) and the foundation on which Global Health was built (2). Moreover, the focus has to be shifted away from geographical boundaries, in order to acknowledge that global health problems also arise in local settings, and to put a bigger focus on the range of skills and perspectives required to understand and act on upstream determinants (5). Thus, postcolonialism can be defined as a critical approach by healthcare practitioners (HCPs) that aims to understand and dismantle unequal power relations that create and perpetuate health inequities (6).
With that in mind, it is important to encourage certain reflections amongst lecturers and students taking an interprofessional global health course. These reflections should include: understanding how systems are rooted in colonial practice, and how this perpetuates the experience of health inequities and the delivery of services; reflecting on how colonialism has shaped the way healthcare practitioners define health, illness, healthcare, medicine, well-being and ability in our society; and understanding how current or future HCPs’ own experiences of privilege and oppression will affect their practice (7).
For example, it is important for HCPs to embrace the knowledge and teaching of Indigenous peoples in order to help their Indigenous patients heal (8). This is done by challenging the assumptions we have and by being that the Aboriginal ways of doing is not valued (7). In the process of decolonization/postcolonialism, it is important to reject universality (the idea of “one-size fits all”, and that the solution to a health problem is the same for everyone), and to understand the upstream colonial repercussions on today’s health inequities differ for different populations (2). Indeed, Canadian-trained HCPs who are involved in Global Health initiatives can become perpetrators of colonial practice if they are unable to adopt a critical point of view on their own bias, and if they are unable to recognize and deconstruct Western dominance in healthcare practice (9).
In conclusion, understanding the colonial repercussions in Global Health can give us a better understanding of the flow of power and knowledge in Global Health practices, beyond the study of the health disparities that are seen in local and international settings.
References
1. Keller RC. Geographies of power, legacies of Mistrust: colonial Medicine in the Global present.
2. Affun-Adegbulu C, Adegbulu O. Decolonising Global (Public) Health: from Western universalism to Global pluriversalities. BMJ Global Health. 2020 Aug;5(8):e002947.
3. Horton R. Offline: Is global health neocolonialist? Vol. 382, The Lancet. 2013. p. 1690.
4. Pai M. Global health still mimics colonial ways: here’s how to break the pattern. https://theconversation.com/global-health-still-mimics-colonial-ways-heres-how-to-break-the-pattern-121951. 2019.
5. van Wees SH, Holmer H. Global health beyond geographical boundaries: Reflections from global health education. Vol. 5, BMJ Global Health. BMJ Publishing Group; 2020.
6. Browne AJ, Smye VL, Varcoe C. The Relevance of Postcolonial Theoretical Perspectives to Research in Aboriginal Health. Vol. 37.
7. Beavis ASW, Hojjati A, Kassam A, Choudhury D, Fraser M, Masching R, et al. What all students in healthcare training programs should learn to increase health equity: Perspectives on postcolonialism and the health of Aboriginal Peoples in Canada. BMC Medical Education. 2015 Sep 23;15(1).
8. Lavallee LF, Poole JM. Beyond recovery: Colonization, health and healing for indigenous people in Canada. International Journal of Mental Health and Addiction. 2010 Apr;8(2):271–81.
9. Racine L, Perron A. Unmasking the predicament of cultural voyeurism: A postcolonial analysis of international nursing placements. Nursing Inquiry. 2012 Sep;19(3):190–201.
About the Author
Nardin Farag is a second-year medical student at McGill. She is one of the student coordinators for this year's Interprofessional Global Health course. While diving into the research on the this year's theme: Decolonizing Global Health, she put together this short piece to explain what is the meaning of this topic and its importance in Global Health practices.