Global health: Between post-colonial continuity, neoliberal neo-colonialism and reductionist decolonisation

Abstract

In recent decades, decolonisation and more recently, decoloniality have gained increasing significance in global health. Growing recognition highlights the need to overcome colonial patterns originating in tropical medicine and perpetuated through international health. Structural inequalities inherited from colonialism continue to affect primarily Black and Indigenous populations in former colonies, demonstrating persistent historical injustices. However, the debate on global health decolonisation remains largely driven by institutions and academics from the Global North, particularly Anglo-Saxon scholars, limiting a genuinely pluralistic understanding of colonialism’s health consequences. This article argues that decolonisation alone is insufficient and proposes decoloniality as a broader framework. This perspective requires critical analysis of contemporary power structures shaped by neo-imperialism, capitalism and neoliberal globalisation, which reproduce discrimination, inequality and oppression worldwide. Furthermore, it contends that the debate must recognise the risks of neo-colonisation driven by the global financial aristocracy, whose growing concentration of political power creates new forms of domination. The emancipatory potential of decoloniality in global health therefore depends on simultaneously addressing colonial legacies and contemporary dynamics, enabling more equitable health governance, inclusive knowledge production, epistemic justice, meaningful participation by historically marginalised communities, equitable partnerships, sustainable institutional transformation, shared accountability, mutual learning, respect for diverse epistemologies and global justice.