Health systems still carry colonial hierarchies, argues new decolonization commentary

A new perspective article argues that modern medicine cannot be understood as a neutral scientific enterprise, because it emerged alongside European colonial expansion and continues to operate within hierarchies that position Western knowledge as universal while marginalizing expertise from the Global South. The commentary, published in Discover Health Systems on 10 October 2026, was written by Gilbert D. Bernardino Jr. and synthesizes postcolonial and decolonial theory into a proposed framework for restructuring authority, accountability, and knowledge within contemporary health systems.

The author contends that the scientific method and colonial capitalism developed simultaneously during the fifteenth century as interconnected projects concerned with classifying, organizing, and controlling both biological systems and human populations. Health systems, on this account, helped classify, manage, and discipline colonized populations, while scientific authority frequently legitimized political domination. The article describes the resulting condition as “coloniality”: the enduring logic through which Western epistemologies continue to dominate global systems long after formal colonial administrations disappeared. In the health sciences, this manifests as a persistent “West is Best” bias, in which Western biomedical research is treated as the universal gold standard while knowledge produced in the Global South is often viewed as secondary, contextual, or anecdotal.

Historical examples anchor the argument. In Uganda, British colonial authorities governed through indirect rule, leaving local chiefs as visible leaders while stripping them of sovereignty and transplanting British legal frameworks with little regard for local traditions. Colonial responses to sleeping sickness between 1900 and 1908 were framed as public health measures but enabled the imposition of ordinances without meaningful community participation, and entire populations were relocated under the justification of disease control, consolidating island communities onto the mainland in ways that also facilitated control over resource-rich territories. Campaigns targeting venereal diseases, the article notes, gave colonial administrations opportunities to intensify surveillance and promote missionary Christian norms around sexuality. In Tanzania, the Maasai were confined to restricted territories under German and later British rule to make space for European trophy hunting and conservation projects, with pastoralist mobility portrayed as aimless wandering rather than a legitimate system of land stewardship. When Maasai communities experience poor health outcomes today, the commentary observes, explanations often focus on “culture” as the problem rather than on political exclusion, land dispossession, and economic marginalization.

The article draws heavily on Frantz Fanon, who understood colonialism not only as a political system but as a psychological and ontological project operating through a “Manichean logic” that divided the world into binaries of civilized and savage, human and subhuman. Fanon introduced the concept of sociogenesis to explain that the mental distress experienced by colonized populations emerged from toxic social and political conditions rather than innate pathology, and he described colonized subjects as existing within a “zone of non-being,” an ontological condition in which they were denied full humanity through the constant imposition of the white gaze. The author argues that this analysis remains relevant to contemporary health systems in which racialized communities encounter clinical environments that pathologize difference while obscuring the structural violence responsible for illness and suffering.

Walter Mignolo’s concepts feature prominently in the framework. Mignolo challenges what he calls the “hubris of the zero point,” the belief that Western knowledge speaks from a neutral, objective, and universal position while all other forms of knowing are treated as merely local or inferior. His call for “epistemic disobedience,” defined as a de-linking from the modern political episteme, seeks to free knowledge production from colonial geopolitical hierarchies. In global health research, the article applies this to practices that privilege quantitative, Western-centered data as the only legitimate form of evidence while dismissing storytelling, oral histories, Indigenous healing systems, and community narratives as anecdotal. Mignolo’s vision of “pluriversality” proposes a world where multiple cosmologies and knowledge systems coexist as co-equal authorities rather than being ranked against a singular Western standard.

The commentary also examines structural asymmetries in contemporary research. Stewart’s concept of “asymmetrical ignorance” describes how scholars in high-income countries can afford to ignore knowledge from the Global South, while researchers in low- and middle-income countries cannot afford to ignore Western scholarship because professional legitimacy, publication opportunities, and funding often depend on it. Abimbola’s “foreign gaze” captures a related dynamic in which researchers from the Global South write for Western journals, donors, and audiences rather than for the communities most directly affected, so that complex local realities become simplified or reframed to appeal to foreign expectations, and research prioritizes externally visible “surgical” interventions over slower, community-driven “organic” social transformation. The article further critiques Teju Cole’s White Saviour Industrial Complex, in which Western intervention is often motivated less by justice than by the desire for a “big emotional experience” that confirms the moral self-image of privileged actors, manifesting in short-term medical missions, parachute research, and donor-driven interventions that may alleviate immediate suffering while reproducing dependency and neocolonial power relations.

A central warning comes from Eve Tuck and K. Wayne Yang, whose influential argument that “decolonization is not a metaphor” cautions against institutions that reduce decolonization to diversity initiatives, inclusive language, or moral self-reflection while leaving structures of land, power, and capital intact. They insist that decolonization must bring about the repatriation of Indigenous land and life, and they describe “settler moves to innocence,” strategies through which privileged actors seek relief from guilt without surrendering authority or material advantage. The author applies this critique to global health institutions that publicly embrace decolonial rhetoric while maintaining unequal authorship hierarchies, funding monopolies, and extractive research practices, and notes that representation without redistribution leaves the underlying structure intact.

On the constructive side, the article highlights Global Health Reciprocal Innovation (GHRI), a framework grounded in the principle that all people are equal knowers and learners capable of co-creating solutions to shared challenges. Unlike older “reverse innovation” models, which still imply that innovation normally flows from high-income to low- and middle-income countries, GHRI reframes global health as bidirectional learning. Practical examples include mosquito-net mesh for low-cost hernia repair, sterilized hardware drills for orthopedic surgery, and Tilapia fish skin for burn treatment, alongside Brazil’s Community Health Worker model, which has informed pilot programs in the United Kingdom. The article cites an evaluation of a Community Health and Wellbeing Worker pilot in a deprived Westminster ward, adapted from the Brazilian Family Health Strategy, which used routine primary care data from 662 households between July 2021 and April 2022 and reported a 40 percent higher uptake of vaccinations, screenings, and health checks among visited households, with increased COVID-19 and influenza immunization, higher cancer screening, greater NHS Health Check uptake, and a modest reduction in general practitioner consultations, despite COVID-19 disruption and a short evaluation period.

The proposed pathways span multiple domains. Within institutions, the author calls for co-principal investigators from the Global South, grant funds administered and spent within local institutions, and shared governance structures with rotating leadership. In knowledge production, decolonization requires reflexivity, co-production of research agendas shaped from the outset by local priorities, and recognition of Indigenous knowledge systems as legitimate forms of understanding. In clinical practice, the article advocates cultural safety, in which the quality of care is judged by the patient’s experience, illustrated by the suggestion that Tanzania employ Maa-speaking health professionals or patient advocates so that Maasai patients are treated as persons of value rather than as cultural obstacles to care. At the governance level, the commentary proposes legal audits of colonial-era health legislation in postcolonial contexts such as Uganda, alongside reassessment of missionary-influenced training models that prioritize religious doctrine over human rights and evidence-based practice. Ethical reciprocal innovation, the author stresses, demands equitable memorandums of understanding, protection of intellectual property rights, fair benefit-sharing, and mechanisms preventing parachute research.

The commentary closes by insisting that meaningful change cannot rely on individual goodwill alone. Institutional accountability requires formal policies with clear, measurable commitments backed by leadership and resources, and without enforceable mechanisms, reform remains aspirational. The author argues that without transforming who controls funding, research agendas, and epistemic authority, decolonization remains incomplete, since these centers of power determine which diseases attract investment, which communities become objects of research, and whose suffering is rendered visible. Real change, the article concludes, will be measured not by institutional rhetoric but by whether sovereignty, dignity, and health outcomes are materially improved for those long denied them. As a perspective piece, the article offers an argumentative synthesis rather than new empirical data, and its proposed framework is presented as a contribution to ongoing decolonial debate rather than a tested intervention.

Subject of Research: Decolonizing global health systems, medical education, and research partnerships

Article Title: Decolonizing public health by addressing power and the architecture of global knowledge production

Article References: Bernardino, G. D., Jr. (2026). Decolonizing public health by addressing power and the architecture of global knowledge production. Discover Health Systems, 5(1), Article 82. https://doi.org/10.1007/s44250-026-00414-y

Image Credits: AI Generated

DOI: 10.1007/s44250-026-00414-y

Keywords: decolonization, global health, coloniality, epistemic injustice, Frantz Fanon, reciprocal innovation, cultural safety, medical education, research partnerships, health governance, Global South, pluriversality