Introduction: A decade of debate, a call to action
Decolonizing global health has emerged as a critical lens for rethinking power, knowledge, and governance in international health. A recent scoping review screened 1,536 articles to identify what decolonizing global health means, its core components, proposed actions, and who is contributing to the dialogue. The findings reveal a multi-faceted movement anchored in power rebalancing, epistemic justice, and genuine agency for LMICs (low- and middle-income countries).
Part I — What does decolonizing global health mean?
Scholars disagree on definitions, but several core concepts recur:
– Eliminating Western supremacy in research and practice (as proposed by Abimbola and Pai).
– Empowering marginalized populations to participate on their terms, embracing diverse cultures and knowledge systems (as described by Besson).
– Addressing three enduring pillars: power asymmetries between global north and south, the colonial legacies that persist in global health, and epistemic injustice that privileges Western know-how.
Theme 1 — Power asymmetries
High-income countries (HICs) dominate funding, leadership, and publication venues, shaping priorities often without meaningful input from LMICs. The COVID-19 vaccine inequities and vaccine passport debates spotlight these disparities. The review highlights that most global health organizations are HIC-centered, with governance and data ownership frequently reflecting northern interests.
Theme 2 — Colonial legacies and neocolonialism
Parachute research, saviourism, and intellectual property dynamics illustrate how colonial patterns persist. Researchers from the global north often control study design, funding, and dissemination, while LMIC partners may experience limited authorship credit and data ownership. The result is ongoing dependency and mistrust.
Theme 3 — Epistemic injustice
Western-centric knowledge hierarchies marginalize indigenous and LMIC knowledge, with English-dominant publication forming a gatekeeping barrier. Calls arise for recognizing plural epistemologies and for LMIC scholars to publish and lead from within their own contexts.
Part II — Can decolonization be acted on? Proposed actions
The scoping review outlines five thematic avenues for action, acknowledging that some proposals lack robust implementation research but offer essential conceptual guidance.
Theme 1 — Overhauling power structures
Radical redistribution of funding, removal of entrenched privileges, and shifting toward horizontal, relational power structures are common refrains. Some scholars caution that radical changes may introduce ambiguity, but the consensus is that incremental reforms alone will not dismantle coloniality.
Theme 2 — Establishing agency for the global south
Empower LMICs to lead, set research agendas, and own data. This includes reducing parachute research, increasing local authorship, and creating high-impact LMIC journals and institutions. The goal is genuine joint ownership of data and findings.
Theme 3 — Epistemic reformation and pluralism
Move beyond Western universalism to embrace medical pluralism, Indigenous knowledges, and diverse ontologies. This reformation supports a more equitable knowledge ecosystem where multiple ways of knowing are legitimate and valued.
Theme 4 — Education reform
Curricula must critically address colonial legacies, improve access for LMIC students, and integrate responsible research practices. Innovative education delivery, including virtual platforms, can broaden participation and diversify the pipeline of global health scholars.
Theme 5 — Inclusivity, solidarity, and allyship
Allyship requires humility and power-sharing. Transferring seats at the table to LMIC experts, building diverse governance, and aligning with broader social justice movements can advance equity in global health governance.
Part III — Who is contributing to these discussions?
The majority of literature on decolonizing global health emerged from 2020 onward, often in the wake of racial justice movements and the COVID-19 era. The discourse has highlighted gaps in LMIC leadership and regional representation. Authors consistently call for greater inclusion of LMIC voices, with a push to move from HIC-dominated leadership toward equitable, bidirectional partnerships.
Conclusion: Toward a decolonized global health agenda
Decolonizing global health is less about rejecting knowledge from the past than about reframing objectives, accountability, and governance to reduce inequality. Achieving this requires radical but thoughtful reform: empower LMICs, diversify epistemologies, reform curricula, and strengthen inclusive alliances. While the path is complex, the scoping review clarifies the key concepts, actionable themes, and the broad coalition needed to realize a more just global health landscape.
