There are increasing calls to decolonise aspects of science, and global health is no exception. The decolonising global health movement acknowledges that global health research perpetuates existing power imbalances and aims to identify concrete ways in which global health teaching and research can overcome its colonial past and present. Using the context of clinical trials implemented through transnational research partnerships (TRPs) as a case study, this narrative review brings together perspectives from clinical research and social science to lay out specific ways in which TRPs build on and perpetuate colonial power relations. We will explore three core components of TRPs: participant experience, expertise and infrastructure, and authorship. By combining a critical perspective with recently published literature we will recommend specific ways in which TRPs can be decolonised. We conclude by discussing decolonising global health as a potential practice and object of research. By doing this we intend to frame the decolonising global health movement as one that is accessible to everyone and within which we can all play an active role.
The words we choose matter: recognising the importance of language in decolonising global health Recognition of the relevance of colonial history to the contemporary practice of global health is not new, but the recent increase in visibility and prominence given to it by global health institutions and flagship journals is welcome when accompanied by meaningful reflection and action. 1 The goal of decolonising global health is to critically reflect on its history, identify hierarchies and culturally Eurocentric conceptions, and overcome the global inequities that such structures perpetuate. 2 We must reflect on the terminology we use when we discuss global health challenges, phrase research questions, write papers, teach students, or interact with patients, research participants, and the public. Although our choice of words shapes an audience's understanding of global health, the restricted range of expressions and terms prevents us from offering more nuanced and appropriate perspectives. The conceptualisation of English terms in other languages is often limited to literal translation that struggles to reproduce the same meaning, as highlighted by recently emerging technical terms, such as social distancing. Thus, to make real progress in the process of decolonising global health in our minds and practices, awareness, reflection, and change of language are fundamental.Most global health literature is still published in English only. This Anglocentrism narrows engagement with many international readers and poses a barrier to authorship for researchers whose working language is not English, which reinforces the power dynamics of the field. 3 By contrast, it is neither generally required nor practiced for foreign researchers working in low-income and middle-income countries to learn the language(s) of the country or region they are working in. This tendency, plus the absence of mechanisms to connect research networks operating in parallel in different languages, means that an English-speaking academic has little incentive and restricted capability to engage with scientific advances being published in Mandarin, Spanish, French, Arabic, and other widely spoken languages. Finding ways to bridge these language barriers in research and bibliographic databases is a fundamental pathway to knowledge co-production and equal research partnerships.
Building on Black geographies and Black studies, this paper offers critical theoretical reflections on global health interventions in postcolonial societies. Drawing on the work of Christina Sharpe, Katherine McKittrick, and Frantz Fanon I suggest that an epistemic approach rooted in Black studies can offer a novel approach to the study of global health interventions, one that centres Black life, which has long been the subject of colonial violence in medical emergencies. I argue that, given the past history of colonialism and medicine, such an approach is warranted if we seek to decolonise the study and practice of global health interventions. By offering what I call “geographies of the wake,” I focus on care's spatial and political entanglements with violence. I make mention of the initial refusal by Sierra Leoneans to seek care in Ebola Treatment Centres and Holding Units and illustrate the spatial aftermath of colonialism and slavery by offering a brief history of one site long associated with care. I ask that this be read as an analytical opening to, not a comprehensive explanation of, Black geographies, global health and medical care.
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