Decolonising Global Health: Landmark Review Maps a Movement’s Path to Reform

A sweeping synthesis of nearly two decades of scholarship has concluded that the movement to decolonise global health remains dominated by researchers in wealthy countries, lacks a shared definition, and has yet to produce a single evaluated example of structural reform in practice. The scoping review, published in Public Health in Practice, analysed 129 peer-reviewed and grey literature sources published between 2008 and 2024, and offers both the most comprehensive account to date of what the decolonising global health movement actually says, and a pragmatic set of next steps for turning rhetoric into measurable change.

The research team, led by Daniel E. Stewart and colleagues, registered their protocol in advance and followed PRISMA guidelines for scoping reviews. They searched Embase, EBSCO Global Health, Medline and Scopus, supplemented by grey literature searches and citation chasing from seven foundational papers. Because ‘decolonising global health’ is not indexed as a standardised term, the team adapted their search strategy to capture a broad vocabulary including colonialism, racism, epistemic injustice, transnational partnerships and intersectionality. Two rounds of searching, in September 2022 and December 2024, ensured the synthesis reflected the most recent scholarship.

The results reveal a striking asymmetry in who is doing the talking. Of the 129 included papers, 95 were commentary or opinion pieces rather than empirical research. Authors were affiliated with institutions in 56 countries, but the United States (53 authors), the United Kingdom (30) and Canada (17) dominated. Forty per cent of papers were produced by a single author based in a high-income country, compared with just six per cent by a single author based in a low- or middle-income country. Even in collaborations spanning both settings, 69 per cent of HIC-LMIC co-authored papers had a first author based in a high-income country, a hierarchy that shapes whose perspective frames the argument.

Definitional confusion emerged as a central finding. The literature broadly agrees that decolonising global health means acknowledging the field’s colonial roots, challenging power asymmetries in its architecture, removing supremacy from spaces of practice, and grounding education in anti-colonial perspectives. Yet the term itself is contested. Some authors warn against its ‘buzzwordification’, noting that decolonisation carries underdetermined and contested meanings. Others question whether the framework is the right tool at all: one analysis argues it risks undermining confidence in scientific knowledge, accentuating international antagonisms, and discounting progress already achieved. An alternative proposal from researchers in Rwanda suggests that ‘elimination of a white supremacy mindset’ better captures the core problem of assumed racial superiority.

The historical analysis underpinning the review is unflinching. Colonial health developed from European colonial ventures in the sixteenth and seventeenth centuries, when unfamiliar disease environments were treated as threats to imperial missions. By the late 1800s, malaria was considered the largest obstacle to colonisation, and treatments were developed primarily to protect colonial administrators and the labour forces they exploited. Indigenous forms of understanding were devalued and replaced by technocratic experts with little concern for local socioeconomic realities. The reviewers note that even The Lancet was born, at least in part, as an instrument to advance British imperial objectives, and that these colonial practices have been codified into modern states, economic systems and international institutions that continue to reinforce bias.

Why does this legacy matter now? The reviewers identify two catalysts for the recent proliferation of literature: the Black Lives Matter movement, which raised global awareness of social justice across professions, and the COVID-19 pandemic, which exposed stark inequities in access to vaccines, personal protective equipment and treatments, alongside power imbalances in international research partnerships. The colonial inheritance also persists in clinical practice itself: the default patient in medical education is often assumed to be a white male, and white European biochemical and visual norms used universally can increase the risk of misdiagnosis across diverse populations.

From the synthesis, four overlapping approaches to action emerge. The first addresses epistemic injustice, the systematic exclusion of local expertise and the dismissal of local knowledge production as illegitimate. Recommendations include re-legitimising indigenous knowledge, diversifying journal editorial boards, ensuring equity in data collection and ownership, and including representative participants in clinical trials so that low- and middle-income settings are not dependent on guidelines derived elsewhere. The second concerns partnership working. Empirical studies in the review consistently document that despite commitments to equity, resource control and decision-making authority remain concentrated in high-income institutions throughout the project lifecycle. The principle of ‘no research about us, without us’, adopted by a community engagement programme spanning Brazil, Ethiopia and Sri Lanka, is held up as a model, alongside calls for funding that flows directly to institutions in the Global South rather than through ‘feudal intermediaries’.

The third approach targets governance. Authors argue for restructuring the political economy of global health, beginning with debt cancellation and non-earmarked budget support, fairer allocation of resources, and stronger accountability from donors. Workforce reforms feature prominently, including ending the ‘brain drain’ of health workers from poorer countries and changing where global health education physically takes place. The fourth approach is individual: practitioners are urged to reflect on their own colonial conditioning, question institutional practices, and speak out, with the caveat that reflection must be matched by peer dialogue and collective action rather than remaining a private exercise.

Barriers to implementation are formidable. The review highlights the psychological legacy of colonial education, which instilled a sense of inferiority that must be actively dismantled. It notes the persistent undervaluing of science produced in low- and middle-income countries, and the argument that meaningful decolonisation may require transforming the global political economy itself, challenging concepts of ‘aid’ and ‘sustainability’ that obscure ongoing economic oppression. Most strikingly, not one of the 129 included papers reported the results of an implemented decolonial intervention. The reviewers suggest this reflects a structural tension: the changes called for depend on the very global health institutions that the literature identifies as part of the problem.

The authors are candid about their own positionality, acknowledging that they write primarily from high-income institutional perspectives and relied exclusively on English-language sources, a limitation that likely excluded distinct decolonial discourses in Spanish, French, Portuguese and indigenous languages. Their proposed next steps are correspondingly pragmatic: re-engineer academic quality assurance frameworks to reflect plural epistemic viewpoints, prioritise research and leadership opportunities for actors from the Global South, embed explicit assessments of power asymmetries in partnership evaluations, direct financial flows to LMIC-led collaborations, and develop contextually valid metrics for tracking institutional performance. They point to models such as the Africa Centres for Disease Control and Prevention’s ‘New Public Health Order for Africa’ as evidence that centring local priorities can be operationalised without Western-defined terminology. Whether the field can move from a movement of commentary to one of accountable, evaluated change, the review concludes, will determine whether global health finally delivers on its foundational commitment to equity and justice.

Subject of Research: A scoping review of definitions, colonial legacies and reform pathways in the decolonising global health movement

Article Title: Contemporary accounts and future directions for decolonising global health: A scoping review

Article References: Stewart, D. E., Amsalu, T., Fairfoot, E., Keen, D., Keenan, J., Butcher, F., Miles, K., & Razavi, A. (2026). Contemporary accounts and future directions for decolonising global health: A scoping review. Public Health in Practice, 12, Article 100874. https://doi.org/10.1016/j.puhip.2026.100874

Image Credits: AI Generated

DOI: 10.1016/j.puhip.2026.100874

Keywords: decolonising global health, global health equity, epistemic injustice, colonialism, scoping review, health partnerships, global health governance, research funding, LMIC authors, COVID-19 inequities, medical education, public health