Introduction
Decolonizing global health is a growing movement that seeks to dismantle the enduring power imbalances and colonial legacies that shape global health, from funding to knowledge production. A comprehensive scoping review of 91 articles published since 2020 highlights three core objectives: redefining power structures, restoring agency to the global south, and reforming epistemic foundations to embrace pluriversal ways of knowing. This article synthesizes the defining ideas, proposed actions, and the actors shaping this pivotal field.
What does decolonizing global health mean?
Scholars diverge in wording but converge on a central aim: to free global health from Western supremacy and to recognize and legitimize non-Western knowledge and leadership. Definitions range from removing supremacy in practice to enabling marginalized communities to participate in scientific advancement on their own terms. The literature consistently foregrounds three interlocking themes: power asymmetries between the global north and south, the colonial legacies (and neocolonial practices) that persist in research and funding, and epistemic injustice that marginalizes LMIC and Indigenous knowledge.
Key themes driving critique
Power asymmetries
Despite progress, voices from LMICs remain underrepresented in decision-making, funding allocation, and priority-setting. The concentration of global health leadership in high-income countries, coupled with grant structures and publication norms that favor Western institutions, sustains North–South inequities. The COVID-19 vaccine distribution gap and vaccine apartheid surfaced these disparities vividly, illustrating how wealth and influence shape access to life-saving tools.
Legacy of colonialism and neocolonialism
Historical dominance persists in who designs studies, frames questions, and controls data. Parachute or parachute-like research, where external researchers lead projects with limited local involvement or credit, reinforces dependency and marginalization. Intellectual property regimes and English-language publishing norms further entrench the advantage of HICs over LMICs.
Epistemic injustice
Western biomedical paradigms are often deemed universal, sidelining Indigenous and LMIC epistemologies. This epistemic hierarchy affects what counts as legitimate knowledge and who is authorized to publish. To counter this, scholars advocate for medical pluralism, local leadership in knowledge production, and the creation of platforms that elevate non-Western voices.
Can decolonization be acted on? Key actions
Overhaul power structures
Radical redistribution of funding, dismantling current hierarchies, and transitioning to horizontal, collaborative models are frequently proposed. Some argue this will come with costs to incumbent institutions, but that such changes are essential for sustainable, equitable outcomes.
Establish agency for the global south
Ownership of research data, leadership roles, and locally driven agendas are central. Calls include LMIC-led journals, high-quality schools of public health in LMICs, and reciprocity in partnerships to replace parachute research with equitable co-creation and primary LMIC authorship.
Epistemic reform and pluralism
Rejecting a universal, Western-centric knowledge system, scholars push for embracing pluriversalities of being and knowing. This includes legitimizing Indigenous knowledge systems and creating spaces for diverse epistemologies within health education, research, and policy.
Education and curriculum reform
Curricula should address colonial legacies, include responsible conduct for international collaborations, and de-emphasize epidemiological biases that privilege Western perspectives. Remote and inclusive education models can broaden participation from LMIC scholars.
Inclusivity, solidarity, and allyship
Allies must transfer power, embrace accountability, and support diverse leadership in governance bodies. The movement benefits from cross-multural solidarity with broader social justice campaigns that advance equity and human rights.
Who is contributing and where does the literature come from?
The bulk of decolonizing global health scholarship emerged from 2020 onward, with many studies referencing the COVID-19 era and the George Floyd–Black Lives Matter context. Analyses reveal that first authors are predominantly from high-income regions, though there is a strong push to elevate LMIC voices and leadership in both research and practice. The discourse emphasizes global south agency, equitable partnerships, and the redistribution of influence to counter historical asymmetries.
Conclusion
Decolonizing global health is not a rejection of all Western knowledge but a movement toward equitable, diverse, and accountable global health systems. By restructuring power, elevating LMIC leadership, embracing epistemic pluralism, reforming education, and strengthening solidarity, the field can better address inequities and ensure health outcomes that reflect the needs and wisdom of people worldwide.
