{"paper_id":"16b4ea33-b124-4669-83d4-e8448419b3f3","body_text":"1 \n \nFULL  TITL E: D ec oloni sing Glob a l Heal th: a  s c oping rev iew 1 \nSHORT T ITL E: Deco l oni sing Globa l  H e al th : a sc oping r ev iew 2 \nAU T H ORS :  D a n i e l  E  S t e w a r t 1, 2, * , T i r u ne h  A ms a lu 3 , E l l ie F ai rfoot 4 , D a vid K een 5 , J e ssica  Keen a n 6 , 3 \nFranc e s Bu tcher 1, 7 , Kevi n Miles 5 , A hmed Ra z av i 1 4 \nAFFIL IATIONS : 1 . In te rnati ona l H eal th Regulatio n s S tren gth ening p r o ject,  Glo ba l Op era tion s, UK  5 \nHealth S ec uri t y  Ag ency , L ondon, UK 2. UK F ield Epide miology  T r a ining Progr a mme (U K - F ETP ), UK 6 \nHealth  Sec ur i t y  Age nc y, Londo n  UK 3.  Afr ic a  C ent r e s fo r Dis ea se  C ontrol an d  Pre ventio n, Addi s 7 \nAbaba , Ethi opia  4. UK Public  Heal th Ra pi d Suppo r t Te am, UK Heal th S ecuri ty Age ncy  5. Global H ea lt h  8 \nUnit, N HS  Eng land, L on don,  UK 6 .  W o rkforc e , Trai ning  a nd  Educa t i on, N HS  Eng land, L ond on, UK 7 .  9 \nThe  Ethox Ce n t re,  N uf fi el d De par tment o f Popul a tio n Heal th, Univ ersi ty o f  O x fo r d , O x f o r d, U K 10 \n*COR RESPO N DI N G  AU TH O R : Dani el S te w art dnldwrd stwr t @gm ail .c om  11 \nAU T H OR C ON T RIB UT ION S : D a ni el E Stewa r t: Conc ep tuali sa tion,  d ata c ur a t i o n, formal a n alysi s ,  12 \ninv es t ig ation , visu al i s ati on , p r oj ect admi n is t ra tion, w r i ting  or i gin al d raft, r evi ew and e di ting Tirune h 13 \nAmsalu : Conc e ptu alis atio n, fo rmal anal y s i s, inv e s tiga t i on, writi ng origina l dr a f t, revie w and editing  14 \nEll ie Fair foo t: Conc ep t ua li sa tion , da ta c uration , formal ana ly si s , inv e stig ation , v isuali s ation , writing  15 \norigin al dr aft, rev iew and  edi ting Da vid K een:  Co nceptu al i s a t i o n, d ata  cura ti on, for ma l an aly si s,  16 \ninv es t ig ation , writing o rigi nal dr aft, r e vi ew a nd edi ting J e ss Kee n an: Dat a cura ti on, formal an alysi s,  17 \ninv es t ig ation Fr ance s  Bu tcher : W riti ng  origi nal draft, r evi ew and edit ing  Kev in Miles :  18 \nConc ep tuali sa tion, d ata cu rati on,  forma l ana lysi s , inv e stig ati on, s upe rvi s io n , w riting  orig inal dr af t,  19 \nrevie w and editing  Ahm ed Razav i: Co nc eptual i sa t io n , da t a  c ur ation , fo r ma l ana ly s is , inves tiga t i on ,  20 \nsup ervisi on, w r i t i ng origin a l dra ft, revie w  and editing   21 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \nNOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.\n\n2 \n \nABSTRACT  22 \nThoug h much  has bee n w r i t t en abou t th e importanc e of d ec oloni sing g lobal h e al th, th ere i s a l ack  of  23 \nco ns e ns us  ar ound h ow it sh ould b e  de fined,  conc ep tuali sed  and  a ctio n ed, an d who h a s 24 \nre spon s ib ili ty to d o so. In a cc orda nce wit h PRIS MA g uid eline s , w e  unde rto ok a  s c oping r ev iew  o f t h e  25 \ndec oloni sing global  heal th li t e r a t u re to e x plore th e m e aning  o f d eco loni sing gl ob al he al th, to i den tify  26 \nex amples o f b est prac t i ce, a nd to find o ut how tho se wri ting ab ou t  th e is su e s e e the futu re o f t h e  27 \nmove ment.  28 \nWe s earch ed  dat aba se s fo r  pe er-rev iew ed  and grey  liter atu r e  with ti tle s and ab stract s, a nd then ful l  29 \ntext s double - scre ened  by  autho rs to ide ntify pape rs for  inc lu sion . O u r  sea rch strateg y focu s s e d o n  30 \nopini on s  a nd discou r se u sing term s br o a dly l inked to d ecolo nis i n g globa l hea lth .  Pape r s publish ed i n  31 \neithe r the pee r r evie wed and  g re y lit era ture  were  eli gibl e for  incl u s io n.  Da t a , in clud ing con clusi on s  32 \nand r eco mmenda tion s, w ere  extr acted  and  r es ult s  p re s e nt e d a s  a n arra tive s y nthe s i s  of i nclude d  33 \npape rs t o provid e a c on tempor ary a ccou n t  of t h e dec ol oni sing g lobal h eal th ag en da.  34 \nInc luded pa p ers ( n=129 )  w e re pre domin antly  commen t a r y  or  opi nion pi ec e s  (n= 9 5). Au t h ors o f t h e  35 \ninc luded p ape r s  w ere aff ili a ted wi t h in sti tution s p redomin a nt l y from hig h inco me coun t rie s inc ludi ng  36 \nthe US A (n =53) and  UK (n =30 ).  Inclu de d pap er s  p re sent ed a b roa d r a nge  of de fini tion s fo r  37 \ndec oloni sing g lobal heal th, d e s c r ibe  th e histo r ic al, c olo nia l infl uen ce on glob al  he alth, e xplor e pow er  38 \nimba lanc e s  in curr ent gl obal h ealt h str ucture s, a nd ma ke a numbe r of s ug ge s tion s  a s to how t o  39 \naddre s s t h e s e imbala nc e s.  40 \nDe spit e the cl ea r impera tive  in the lite ra ture to t ake  action , t he re is  no clea r  c onsen s u s on w her e to  41 \nsta r t . Dr awi ng from the fi nding s  o f our r evie w, w e conc lude w ith a set o f r e com men ded appro ac he s  42 \nand n ext s te ps for d ecol oni s i ng glob al h eal t h ,  foc u s s ing  on epi s t e mic in ju s tic e , p artn er s hi p working ,  43 \nthe struc ture  of glob a l hea l t h , and i ndivi dua l duty.   44 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n3 \n \n1. INTR ODUC TION  AND BACK GR OUND 45 \nGlobal he alth acto r s a nd institu tion s mu st  hold  t he princ iple s o f equity and  j usti ce  at the  c ent re o f 46 \nwha t the y s e t  out to ac hi eve . H ow ever, ther e is much w or k  t o  b e done. The  inte r n ation al re spon se  47 \nto t h e  C O VI D-19 p andemi c h as , to  a la r ge ex ten t, r ein forc ed pr e -exi sting struct ural ine q uitie s a nd  48 \ninjustice s.  49 \nA key  i njustic e rela te s t o the  c ont i n uing leg acy  of ou r  c olonial  pa s t . The dec olo nising  g lob al he a lt h  50 \nag enda r ecog ni s e s  th at the way  in whic h global  he al th i s taug ht,  p r a ct ise d and  impleme nt ed o ft e n 51 \nperpe tua te s hi sto r i call y roo ted an d expl oitative p o wer st r uc t ur e s, and  s e e ks t o  a ddre s s  thi s.  52 \nThoug h mu ch ha s  be en  wri tte n abou t the  impo rtanc e o f d ec oloni sing globa l  hea lth  in  t he p eer -53 \nrevie wed and grey  lite ratu re, t he only  ot he r  r e view , t o our k nowled ge, foc us e s  spec i fica lly o n 54 \ndec oloni sing globa l h ea lt h ev alua tion [ 1]. T hi s  re view  re spo nd s  to a gap in the  lite ra ture a bou t  55 \nco nceptual i s i ng the  dec olo ni sing heal th mov ement by  explo r in g wha t i s  w ritten  i n the  pe e r  r ev iewe d  56 \nand grey liter atur e a bou t de coloni sing  glo bal health . This revi ew a s s e s s e s t h e  litera ture t hroug h  57 \niden t i fy ing th e ke y them es  and  to  gene ra t e  a  set of  ac tio ns for glo ba l h eal th a c t ors and  i n s ti tutio ns  58 \nlook ing to tak e a d ecolo ni s in g app roac h.  59 \nOur  s pec i fic  aims wer e t o :  60 \na. Coll ate a nd critic ally  app rai se publ ica ti ons foc u ssed on d ecolo ni s in g glob al he a l th;  61 \nb. E xplore t heme s  w ithi n th e li tera tur e, i ncludi ng th e c oncep tua li s a t i on and  de fini tion s o f  62 \ndec oloni sing global  he alth , e xampl e s  o f best prac tice acti on s to d ec oloni se g lob a l he alth , and t h e  63 \nch alleng e s  t o a nd oppor tuni tie s for ac t i o n on thi s age nda ;  64 \nc.  Gen era te a set o f p ropo sal s w ith  a vie w t o direc t  fu ture  re s earch a nd acti on  foc u ssed o n  65 \ndec oloni sing global  he alth .  66 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n4 \n \n2. MET H O DS  67 \nWe un der took a scopi ng  review  of t h e  l i ter a t u re in  a cc or d a nce w i th PRIS MA  guidel ine s f o r scopin g  68 \nrevie ws [2] a nd gui ded by  the meth od ologic al fr a mewo rk propo s e d by Ar k se y  and  O’Malley [3 ].  69 \nSc oping r ev iew s a re w ell  suit ed t o pr ovi ding an  overvie w of  ev idenc e and  fo r c la rifying  conc ep t s  a n d  70 \ndefini t i on s  [4] . The pr otocol for thi s s tu dy , reg ister ed pri or to i t s und e r tak ing, c an be fo und here :  71 \nhttp s : / /o s f.io /ynpk f/  72 \nEli gibility  criteria an d se arch s tr a te gy  73 \nAny st udy or pa p er t y pe w a s  i nclude d in our revi ew inc luding  public ation s b oth in  the pe er  rev iewe d  74 \nand grey  lite ra tur e . Pap e rs pu b li s he d  i n t h e  Eng li s h  l ang uage only wer e incl ud ed w ith  no  da t e  75 \nre st ric t i on s  o n public a tion da t e  app lie d.  76 \nPap e rs wh ich di r e ctly a ddre ss ed or ex plored d ec oloni sing glo bal  h ealt h, i ncludi ng discu s s i on s  a r o un d  77 \nhow  it is de fin ed, conc ep tuali sed a nd put  into prac tic e w ere e li gible fo r  i nclu sion.  78 \nO u r  se ar ch  s t r at e g y ( S 1  A p pe n di x )  w a s  a d a p t e d t o t he  l it e ra t ur e , wh i c h  wa s p r edo m i n a n t l y fo c uss ed 79 \non opin ion s  a nd di s c ou r s e,  rath er th an, for exa mpl e, int erve n t i on s tudi e s. The  p hr a s e ‘d e coloni s ing  80 \ng l o b a l  h e a l t h ’  w a s  t o o  n a r r o w  a s  l i t e r a t u r e  o n  t h e  t o p i c  i s  fr e q u e n t l y  n o t  l a b e l l e d  i n  t h i s  w a y .  A s  a n  81 \na l t e r n a t i v e ,  w e  u s e d  a  b r o a d  s e t  o f t e r m s ,  a p p l y i n g  a  s y s t e m  fi l t e r  fo r  l e t t e r s  a n d  e d i t o r i a l s  a s  t h e s e  82 \nwe r e  mo st l ikely  to exp r e s s v iews and opinion s. I n a dditi on, a term filte r in th e form o f a se arc h  83 \ns t r i n g  w a s  a l s o  u s e d  t o  n a r r o w  t h e  r e s u l t s .  A l l  t e r m s  w e r e  s e a r c h e d  i n  a b s t r a c t s ,  k e y w o r d s ,  s u b j e c t  84 \nhea ding s, ti tle s and tex t  word s .   85 \nWe s e a r c hed  Embas e, EBS C O Gl oba l H ea lth , Med l ine and Scop u s  bibliog r a phi c datab a se s. A gre y  86 \nlitera tur e se arch u s i ng Goo gle s e a rch a nd Google Sc hol ar wa s al so unde rtake n  to captur e opini on  87 \npiec e s t hat  may no t be  inde xed  by  th e bi bli ographic  da tab a se s.  We  al so und ertoo k  citatio n s ea r c he s ,  88 \nusing a  numbe r of s ou rc e ar ticle s  w hich w e identi fie d fr om  t h e  sea r c h a nd thr ou gh ou r  ow n reading  89 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n5 \n \n[5-14 ] . To  en sure t h e  lit era ture we i nclu de d was a s up to dat e a s  po ssible , w e un derto ok sea r c h e s at  90 \ntwo p oint s , the fi rst in S e ptemb er 2022  a nd the sec ond in S ept ember 20 24.  91 \nF u l l  d e t a i l s  o f t h e  s e a r c h  s t r a t e g y ,  s e a r c h  t e r m s  a n d  n u m b e r  o f r e s u l t s  r e t u r n e d  i s  a v a i l a b l e  i n  t h e  92 \nsuppl emen ta r y  mate rial.  93 \nSc reening  94 \nSe arch re sul t s  were de -duplic a ted u sin g Endnote pr i or  to being  scr een ed. Th e large v olume of 95 \nre sulting ar ticl e s  w ere divid ed among st the follow ing author s (D S , TA, EF,  DK, JK, KM, a nd AR). Eac h  96 \ntitle and ab stract wa s  in dep e nden tly scr eene d by a minimum  of two  a ut h o rs o f  the  a b ove auth or s  97 \nusing the  Ra yya n re view  s c re ening tool  [ 15], and di s c ar ded tho se  re cord s  whic h c le arly did  n ot m ee t  98 \ninc lusion cri te ria. T wo aut hor s t h e n i ndepen d ently scre ene d fu ll t ext articl es  f or inc lu sion or  99 \nex clusion.  Di scr epan cie s  or di sa greem en ts  were  a ddre ss ed fir s t  th rough di scu s si on and i f n e ede d by  100 \nreferra l to a third a u thor.  101 \nDat a ex t rac tio n  102 \nDat a was ext ract ed into a pr e -agre ed Micro soft Ex ce l f orm.  Dat a extrac ted in c luded autho r, th eir  103 \ninst itu t i onal aff il ia tion,  an d coun try in  w hic h tha t in st i tuti on i s  ba sed,  t he  d at e a nd where publ i s he d ,  104 \nco untr y  or  reg ion  on whi ch t he  articl e  w as  focu s s e d , k ey conc lu s i on s  and re commend ation s  fo r 105 \nfur ther action . Da t a  we re e xtract ed i nd e penden tly  fo r eac h p aper by  a min imum of two autho rs w ith  106 \ndispa riti e s and d i s a gre emen ts di scu s s e d f i rst a nd re fer red to a t h i r d auth or if n ec essa ry.  107 \nDat a syn the si s 108 \nThe  approac h to da ta synthe si s w a s  guide d by  the aims o f the  st ud y a nd th e need t o ro bustly  109 \npre sen t r e sul ts th at includ e d both a hig h  pr opo r ti on of c ommen tary a nd opinio n-ba s e d a r tic l es , but  110 \nalso h e terog en eou s met hod s among st t h e othe r ar tic le s  (se e r e sul t s).  111 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n6 \n \nAs a c on s eq u ence of t h i s , n o ar ticle s w e re  exc luded o n th e ba si s o f qu ali t y . Thi s w a s  p a r t ly  bec au s e  it  112 \nwa s  no t po s sible to u se a qu a lity a s s e ss ment to ol to a s se ss t he  h et erogen eou s a rticl e s  i nclude d, bu t  113 \nalso b ec au s e  the ai m o f th e s c oping re vi ew was to c olla t e  t he full range  o f w ha t  i s writte n a bo ut  114 \ndec oloni sing g lobal  hea l th.  A r isk w i t h a pplying  a quali t y  a s s e s s me nt to ol t o thi s  l itera tu r e i s tha t i t  115 \nmay  inadv er ten t ly  perp etu ate the sam e bia se s tha t th e deco loni si ng age nda se e ks to a ddre s s. Kha n  116 \net al. [6 ],  argue  th at th e dec oloni sa tio n of ac ademi c p ubli shing s p a ce s ne ed s to ma ke r oom fo r  117 \npubli cation s fr om alt erna te  epi st emic  standp oi nt s  an d  de -emph a sis e tr a di t i onal hie r a r c hi es  o f  118 \nev idenc e and p rac ti s e . This r evie w the re fore seek s t o mee t thi s a spira tion .  119 \nIns te ad, the  au thor s worke d  toge t he r  t o unde rt a k e a  nar ra tive synth e sis o f t h e  fin ding s i n  a ll t he  120 \ninc luded a rt i cle s  to  prov ide  a con tem porary  ac cou nt of t h e  dec ol oni sing g l obal he alth  a gend a .  121 \nNarra t i ve synthe si s ha s b e en sh own  to  be a use ful techni q ue in s y n the s i s ing  diffe ren t typ e s  of  122 \nst u d ie s  wit hout  lo sing the  diver sity in  stu dy de s ig ns a nd  con te xts [16 ].  In  thi s s tud y,  t h e  Mindmei s te r  123 \ntool w a s  used [ 1 7] to di scus s, rev iew,  ma p out a nd agr ee  key  t h em es .  124 \nThe  finding s from the  inc luded artic l e s  a re s um mari s e d  below .  The na r ra tive  s y nth es i s s t a rt s with a n  125 \nana lysi s  o f who talk s  a b out dec ol oni si ng glob al hea lth in the li ter atur e an d  t he  geog rap hica l  126 \ndist r i buti on o f auth or s, d esc ribe s th e c ol onial legac y of glob al  heal th a nd how t hi s  a f f ec t s  th e curr ent  127 \ndefini t i on o f d ecolo ni s in g globa l heal th, progre s s e s on to the r ea son s  fo r dec olon ising gl obal hea l t h ,  128 \napproa ch e s and b arri er s  to t hi s, and  fini she s wi th a n  analy s i s o f th e p er s pe c tive s o f low - or  middl e -129 \ninc ome country (LMI C) a u t h ors . T he d is c u ssion th en c rit i cal ly a naly se s thi s l it er a tu r e  to c on sid er  130 \nga ps , op portuni t i e s  a nd fu ture  re s e a r c h.  131 \nTabl e 1: Summ ary  of all p aper s  inc luded  in t he  re view 132 \n[T A BL E 1: Summary of all p aper s  includ e d in the rev iew ]  133 \n3. RE SU L TS  134 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n7 \n \nEle ctronic da taba s e se arche s ide nti fied  126 8 rec ord s  with a fur t he r  263  rec or d s inclu ded throug h  135 \nci t a t i on  s ea r c he s and  fu rth er  rea di ng (T abl e 1 ). F oll owing  d e -duplic a tion,  ti tle a nd a b s tr act an d f u ll -136 \ntext scree n ing, 12 9 articl e s  w e re inc lude d i n our review  (Fig ure  1: PR IS M A fl ow c hart).  137 \nFig  1: PRISMA F low Diagr am fo r the ide nt ific ation of st udie s  a nd papers  f or inc lusion in the revie w  138 \n[FI GURE 1: P RISM A Flo w Diag ram ] 139 \nThe  majority o f the p a per s in cluded  in o ur revie w we re commen tary  or  o pini on pie ce s (n =95) . O the r  140 \npape rs wer e l it e r a ture o r scopi ng  r e view s  (n =1 3), qu alit ativ e s tudi e s  (n =15 ), mixe d m ethod s  studi e s  141 \n(n=4 ) a nd ca s e s tu die s (n =2) . A u thor s o f t he inc luded ar t i cle s we re a ffilia ted wit h insti tu t i on s  from 5 6  142 \nd i ff e re n t  co un t r ie s ,  wi t h m os t  a u t hor s  ( n= 5 3 )  a ffil i a te d  t o  i nst i t ut io ns  in  t h e U SA , t h e  U K  ( n = 3 0) ,  an d 143 \nCana d a (n =17 ). Mo s t pa p er s  i nclud e d in our rev iew wer e publ i s he d in p ee r-rev iew ed journal s  144 \n(n=11 2) , with thir te en pape rs publi shed i n the non -pe er revi ew ed g r e y liter atu re  and four pub li s h e d  145 \nin b ooks . Artic le s inc luded in  th e review  we r e publi shed b etw e en 200 8 and 2024.   146 \nWho i s talk i ng a bo u t  d ecol oni sin g glo b al hea lth ?  147 \nThe  impac t  o f coloni a li sm on hea l t h  is  f a r  re a ching , and a s such, h a s  a ttr ac t e d int er est a n d  148 \nco mmentary acro s s  many s ecto r s . Th e large st  g r ou p  of au thor s have  wri tt en about  de colo ni s i ng  149 \nhea lth from a  he alth p rovi der per s p ec tiv e. T he s e  per s p ec tive s inc lud e p sych olog y [18 ], derma tology  150 \n[19] , su r g ery [20 -23 ], r a di ology  [24 ],  l in guistic s [25 ], pu blic hea lt h [26 -2 8] , e pid emiolo gy [29] , O ne  151 \nH e a l t h  [ 3 0 ] ,  m e n t a l  h e a l t h  [ 3 1 ,  3 2 ] ,  b i o e n g i n e e r i n g  [ 3 3 ] ,  r h e u m a t i c  h e a r t  d i s e a s e  [ 3 4 ] ,  h e a l t h  c r i s e s  152 \n[35] , he al t hc a re i nnov atio n [36] , aca d e mic med ical  c en tre s  [37 ], emerg e ncy medi cine  [38,  3 9 ] a nd  153 \nglo bal hea l t h  in s ti tuti on s [40 , 41] . Hi st o r ic al per spec tiv e s  ha ve b ee n dra wn upon  [42 ]  a s  hav e t ho s e  154 \nregardin g equi ty - d riv en fun ding  [43 ] and  globa l politic al ec o nomy [44] .  155 \nDeco loni sing  th e re sea rc h sec tor ha s a ttrac te d c ommen tary,  inc luding  re se arch  app r o a che s t o b ig  156 \ndata [45,  46 ],  implem e nta tion sci e nce  [4 7 ], reali s t ev alu ation  [48 ] and p erc eption s  of r e s earc h  157 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n8 \n \nfello w s  [49 ]. S imil arly , r e sea rch par t ne r ship s  [7 , 26, 5 0,  51]  and pu bli shing [ 52 - 5 4]  hav e d raw n  158 \ncritique .  159 \nFi nally,  ma ny paper s  hav e foc us sed on deco loni sing t h e  e duca tion s ector , i nclu di ng global  hea l th  160 \nlea r ni ng [6 , 22, 26, 41 , 55-63 ] ,  hea l t h care pro fe ssion al  educ a tion [58 , 64, 65] a nd edu ca tion al  161 \np a r t ne rs hi ps  [ 6 6,  6 7 ].   162 \nWha t is the g e ogr ap hica l dis tr ib uti on o f aut hor s?  163 \nDe spit e the va r i e t y  o f s e c tors inv olve d  in dec oloni si ng g lobal he alth , th e l oc ation of autho r s  164 \n(ac cording t o t h e  primary  in s titu t i on t h at th e au thor  i s a ff i liat ed with a t t he ti me of  p ublic a t i on )  165 \nshow s a disp arity in w here th e lite ratu re is  being  prod uc ed. F a r more pape r s  (n=51 , 40% ) w er e  166 \nproduc ed by a  s ing le au thor ba s ed in a h igh-in come c oun try (HI C) tha n by a sing l e autho r ba sed in a  167 \nLMIC  (a s  pe r  W orld B ank  cla ssi fica ti on s ) (n=8 , 6%) . Ar ticle s  w it h  multi ple a u t ho r  l oc ation s, p roduce d  168 \nin c olla bora t i on  be twee n  high-in c ome c o untry ( HIC ) b a sed auth or s and  L MI C ba s e d auth or s mad e up  169 \n3 5 %  ( n = 4 5 )  o f t h e  p a p e r s .  P ap e r s  w i t h  m u l t i p l e  a u t h o r  l o c a t i o n s  e x c l u s i v e l y  fr o m  H I Cs  m a d e  u p  1 3 % 170 \n(n=16 ), an d pap er s wit h mul t ip l e a utho r loca tion s  e xcl us iv ely from L M IC s ma de u p 6% (n= 8 ).  In  HI C-171 \nLMIC  r e s e a r c h col labo ratio ns , it is al s o impo r tan t to c onsi der au thor s hi p hi erarchi e s . In th ese  172 \nc ol l a b o r at i o ns ,  6 9 % ( n= 4 7)  h a d  a  fir st  a ut h o r  ba s ed  i n  a  H IC ;  2 2 %  ( n=1 5 )  h a d  a  fir st  aut ho r  ba s e d in 173 \na n  LM I C;  a n d  7 %  (n = 5 ) h ad  j o i n t fi rst  aut ho r s  b as e d  in  a  H IC  a n d  LMI C.  F i gu r es  2 a n d  3  se t  o u t  a  map 174 \nshowing  th e loc atio n of the au thors an d l ead aut hor s  o f i nclude d a rticle s .  175 \n As a l so re por ted by Ree s  et  al.  2024  [ 68], al thoug h  th ere ha s b een an expa n s ion  of public a tion s  176 \nregardin g dec oloni zing global  heal th,  the  na rra tive on  th e se  topic s  ha s  p rima r i ly be e n told b y  177 \na u t h o r s  a ffi l i a t e d  w i t h  H I C s .  T h e  r e a s o n s  f o r  t h e  l a c k  o f L M I C  a u t h o r s ,  a n d  t h e  p e r s p e c t i v e s  fr o m  178 \nLMIC  au thor s , a r e  expl ore d in th e fol l owing  narrative a nalysi s .  179 \n 180 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n9 \n \nFig  2: L ocation of the a ut hors contributing to pape r s inc lude d  in th e rev iew* 181 \n[ F I GU RE 2: Ma p sh owin g the loc a tion o f t he autho r s  c ontr i buting t o pa pers in clud ed in the r evi ew. ]  182 \n* De fini ti on o f auth or loc ati on re fe r s t o  th e primary i n s ti tution tha t the a utho r  is  a f f i liat ed w ith at 183 \nthe time of public a tion .  184 \nFig  3: L ocation of the first  author  o f  pap ers  w it h  multiple authors  i ncluded i n th e review **  185 \n[FI GU RE  3: Ma p sh ow ing the l oca tion o f th e fir st au t h or s o f pape rs inc lud ed i n th e  revie w]  186 \n** This d ata o nl y inc lude s pape rs wi t h m or e  th an one au thor .  187 \nNot e : Fur ther d eta il s  o n t he  numb er s o f author s  from e ach country ar e pr ov ide d a t  t h e  S2 Appe ndix.  188 \nThe  legac y o f  colo ni al he al th  189 \nThe  c once ptua li sat ion o f d e colon i s ing  gl obal he a lth r e st s on und er st anding w ha t c olonia l  heal th i s  190 \nand the  i mpact o f thi s. The di s c ipli ne of c olonia l heal th dev elope d  f rom E ur op e a n col onialis t s  i n t he  191 \n16th and 1 7th c enturi e s , who s a w h ea lth c ondition s un fa miliar to col oni s t s a s a thr eat t o thei r  192 \nmis s i on. Fo r  instan ce, by the la te 1 800s, mala r i a wa s  con sider ed t o be th e large st ob sta cle  t o  193 \nco lonis ation , w ith me t r opol ita n mil ita ry a nd busin es s in ter e sts b eing co mpromis ed by t he  194 \ns u s c e p t i b i l i t y  o f w h i t e  s e t t l e r s  t o  m a la r i a ,  w h i c h  w a s  b y  fa r  t h e  l a r g e s t  c a u s e  o f d e a t h  fo r  t h a t  g r ou p  195 \n[69] . In o r de r  for th e c oloni al  pr o jec t  to succ eed , tr eatm ent s  f o r  di sea se s impac ting c olonia l  196 \nadmi nistra tor s  a s  w ell a s  th e loca l popul a t i on s  w ho se lab our th ey  exp loited w e r e  r e quire d [70 ].  197 \nIn addi t i on t o dev elopin g stra tegie s to pr o tec t the  i n t e re st s  of col oni s e rs , the n ece ssity t o  198 \nunder st and ‘new ’ d i sea s e a etiol ogie s, p att ern s ,  a nd t re a t me n ts of t h e indige no us  popul ation s,  w as  199 \nusually  pit ted  aga in s t  t h e  in te re st s o f t he colon i sed  [71 ].  Col onia l  au t h orit ie s saw  them selv e s a s  200 \nhav ing the r ig ht soluti on s a nd ra rely  c onsid ered tha t  the pe ople th ey we r e t rying to ‘help’ coul d  201 \npos s i bly hav e th eir own s olution s [56] . Most indi genou s form s  of und e rs tandin g w ere deva lued a nd  202 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n10 \n \ndemon i s ed  and we re soo n repla ce d by ‘technoc ra tic expe r t s ’ w ho showe d li tt le conc ern fo r t he  203 \nsocio e conomic  re aliti e s on t he g r ou n d [4 0, 72, 73 ].  Epi st e mic d om inanc e fr om  HI Cs  ca r v ed i t s  place .  204 \nFor ex ampl e,  t he  journal  th e L anc e t w as bor n  a s  a  produ ct  o f colo ni ali sm and , a t l ea s t  i n  par t ,  a s  a n  205 \ninst r um en t t o  s upp o r t a nd adva nce Br i ti s h impe r i al obje ctive s [11] .  206 \nThe  leg acy  of c ol onial  h ea lt h  remain s .  Th e c r e a tion an d domina nce  of c o lon ial,  mis s io n ary a nd  207 \ntropica l  me dicin e  foll owed by int ern ationa l  he alth  a nd n ow global  he al t h, c ontin ue to be  208 \nunderpin n ed by the remnan t s  o f c olo ni al he r i tag e  and p ractic es  [4 0 , 69, 70,  74 -78] . Th e se c oloni al  209 \nprac t i ce s hav e b ee n “c odi fied  i nto mo d ernity, m o der n s t a te s, e cono mic, soc ial, in tellec tu al an d  210 \ni n t e r na t io nal  i ns t i t ut i ons ”  [ 60 ] a n d  t h es e i n s t i t ut i o ns  c o nt i nu e  t o  r e info r ce r a c ism  a n d bi as  [ 26 ].  F or 211 \ninst ance , p opula t i on re fu sal to se ek  ca r e  a s a r e s u lt o f colon ial v iole nc e, c o ntinue s t o ha mpe r  212 \nm o d e r n  d a y  m e d i c a l  e m e r g e n c i e s  [ 7 9 ] ,  w h i l s t  e d u c a t i o n a l  c u r r i c u l a  c a r r y  t h e s e  e p i s t e m o l o g i c a l  213 \nbia se s [60 ], inc luding  t h e exc lusio n of a ‘S outhe rn’ per s p e ctive  in inte rvention  d e s i gn and e valua t i on  214 \nre sea rch approa ch e s [80 ]. Tuhebw e and  col leagu e s  (2023 ) a r g ue tha t c olonia l p ower dyna mics ca n  215 \nbe s een  throug hou t th e projec t  cyc le o f ma ny g lobal h ealth pr ogramme s . [81 ]  216 \nBy i gnoring hi sto ry, and c ontinuing  to a cc ept  power imba lanc e s ,  pa t te rn s  of oppre ssio n a nd  217 \nex ploitati on repr oduc e and s uppor t  the  c urr e n t  sys tem o f glob al heal t h [31 ].  This inclu de s  a  distinc t  218 \npow er  imb alanc e wher e ‘r esou r c e limi t ation s’ in l ow-inc ome  se tting s  hav e alw a ys  be e n e xt ernally  219 \nimpose d [44 ] .  220 \nDefi nin g  th e dec olo ni s i ng  gl ob al  he alth mo vem e nt  221 \nThe  ‘decol oni s i ng glo b al hea l t h ’ movem e nt  t hu s dev elop ed from th e hi st orical  a nd cu r ren t leg acy  o f  222 \nco lonial he alth . D ec oloni sa tion ha s  be en defin ed  a s t h e elimi na tion o f the c ol onia l  exp er i enc e and i t s  223 \nleg acy  [56] to all o w for th e indep e ndenc e and ful l agen cy o f  all inv olve d organi sa tion s, com munitie s ,  224 \nand p ers on s [82] . W h e n ap plie d t o  g l o ba l  he a lt h ,  the  dec oloni sing mov em ent s e eks,  among st o the r  225 \nthings , t o ack nowle dg e globa l  heal th’ s root s in  colon iali sm [11 ]; highli ght an d c hal lenge  the  pow er  226 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n11 \n \nasymme trie s in  th e gl obal  he al t h  a r c hi te cture [83 ];  remov e  all form s  of supr ema c y wi t hi n spa ce s of  227 \nglo bal hea l th prac tic e  [ 7 4 ];  i d e n t i fy w a y s  in  w h i ch  g l o b al  h e al t h t e a c h in g  a n d  re sea r c h c a n  o v e r c o m e  228 \nits c oloni a l pa st  [7, 40 ]; a nd, advoc at e for c ritical  g lobal he a lth educa t i on groun ded in anti -c olonia l  229 \nper spec tiv es  [8 3, 84 ].  230 \nClea r  dis t i nction s, bu t links, ar e al so dr a wn between  o ther simila r  movem en ts, fram ework s a nd  231 \nco ncept s,  inclu ding t he Blac k Liv es  Ma tt er movem en t [83 ][61 ] ,  e qui ty, dive r s ity and inc lu sion  (E DI )  232 \nand anti -rac i s t re fo r m [40, 85] . As  such , deco loni sing globa l he alth can al so be  u nderstood a s a n  233 \napproa ch t o s oc i al justic e a lso inte r sect s  with other ha rmful ‘ -i s ms ’, tha t po s e  t h e  l arge st  th rea t t o  234 \nh e a l t h  e q u i t y  ( e . g .  r a c i s m ,  s e x i s m ,  c a p i t a l i s m )  [ 5 ] .  D e c o l o n i s i n g  i n c l u d e s  a n t i - r a c i s m ,  n o t  j u s t  235 \nequa lity, dive rsity and inc lu s i on i ni tia tives , but n e ed s  t o look at t he  root ca us e s o f st ruc t ural  a nd  236 \nindi vidual  r a ci sm to add re s s  thi s i s s ue [8 6 ] .  The Edi t or s o f th e Lan cet Global H ea l t h  not ed tha t r a ci s t  237 \nste r e o t y pe s have  r e -emerg ed towar ds Afr i ca ns a s  a  r e s u lt o f C OV ID-19  [87] dem on s tr ating t h e  238 \ninter s ection al  na tu r e o f dec olon isi ng glob al heal th. Na ssiri -An s a r i  a nd Rh ul e (2 024) empha si se the  239 \ninter s ection  be tw een race  and ge nde r a nd sta te tha t e f for ts to  dec ol oni se glob a l heal th mu st  focu s  240 \non bo t h r a c e a nd gend e r  equ ality  [88 ].  241 \nHowev er, the t erminol ogy  of dec oloni sin g gl obal hea lth is fa r  f r om uni versa lly a cc epted , lac ks cla r i t y  242 \n[89] , i s p oorly und e rs tood [63 ] a nd vi ewed a s  unc onve ntion a l [90] . Krug man c halle nge s  t h e  243 \n\"buzzwordi fic atio n\"  o f dec oloni sing glo ba l h ealth , empha sizing tha t de coloni s a tion is a  w ord w ith  244 \nunderd ete rmine d and c on te sted  mea nin g s , a ssoci a tion s and r epre s ent ation s [91 ] . 245 \nThe  c omplex ity of wh at it  m eans to  de coloni se g lobal he al th s ho u ld als o  be ac know ledged . 246 \nCont racto r an d D a s g upta  u s e the  exa m ple o f I ndian’ s c as te  sys tem t o  d raw  a tten t i on  to the l oca l  247 \nco mplexi t i e s  o f d ec oloni sa tion,  w arning that  th e Global  S outh  i s  ma d e up  of  div e rse soci eti e s and  a  248 \none- siz e -fi ts all  approach  i s  not app r o pri a t e .  They draw  atten tion to th e his t oric  cultural i mbalanc e s  249 \nof powe r  w hich w ere use d in India by  the colon iser s and whi ch wi ll remain if de coloni sati on oc cur s  250 \nwi t ho ut  rep r e s ent ation from suppr e s s ed  minoritie s [92] .  251 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n12 \n \nBey ond th e discu s sion ove r  what the t er minol ogy of decolo ni s i ng glo bal h ea lt h mean s, th ere i s al s o a  252 \ndeba te  ov er w h ethe r th e  t erminolo gy sho uld be u sed an d w ha t alt ern ative s w ould be pr efera ble .  253 \nSome  auth ors sugge st d ecolo ni s in g glob al  h eal th i s d e fined pred omina nt l y by th os e f r om HI Cs [49 ,  254 \n8 3 ] ,  pr ed om i n a nt l y  w i t h i n  u ni v e r s it ies  in  H I C s  a n d  t h er efo re  a r e  n ot  d e f ine d  b y  t h os e  at  t he  255 \nrece iving  e nd  o f th e in te rven t io n s, th us pe r p e t ua t i ng existi ng pow er a nd k n owle dge struc t ur e s [7 ,  256 \n40].  F or  e xampl e, Enge bre tsen c r i tiqu e s the de coloni s ing  global  heal th mov eme nt, arguin g tha t t he  257 \nrheto ric o f dec oloni sing  g lobal h eal th h a s d one  not hing  t o add re ss the  ro ot c au s es  o f the dis a s tr ou s 258 \nhea lth s i tua t i o n in Gaz a and  t h e  We st Ba n k [93] .  259 \nHellow ell [94 ] qu e r ie s w heth er a d ec olo nising gl ob al h ea lth  fr a mework  is  th e b e st  s olu t i o n t o  i ssu es  260 \nwi t hi n global  heal th. A prob lem wi t h thi s t erminology  i s  th at it i s ass oc iat ed wit h bina r y  argumen t s  261 \nwhi ch plac e p e ople  int o g r oup s  o f opp re sse d and  o ppre s s o r s de pe nding on the ir  b ac kground o r  262 \npla ce of o rigin.  He sugge st s tha t  soluti o ns de rived th rough thi s le ns h ave  th e p oten tia l t o harm t h e  263 \naim s  of th e globa l  he alth  ag end a by :  ‘ (i ) und ermini n g  confi de nce  i n s c ien t ific  know led ge;  i i)  264 \nac centua tin g  in ter -gro up an d in ter -n ati ona l  an ta goni sms ; a nd  (iii ) by  disco un ting  t he d egree  o f  265 \nprogre s s  a lre ady a chie ved th a t  m ay c ur tai l opp ort uni tie s for re dis tr i b utiv e chan g e  in the  fu t u r e ’.   266 \nBina gwah o et al p rov ide an al te rnat ive to decolo n i s in g glob al  hea l t h ,  arguing  tha t th e “ el i m in at i on o f 267 \na w hite  sup r e macy  mind se t”  is  a b et ter pos i t io ne d t erm, a s i t  rec ogni se s t he  cru x of c oloni sa tion a s  268 \nas s u med r a cia l s up e r io r i ty,  and how t he  le gacy  of suc h s u s tain s th e pr i vileg e white pe ople enjoy  a t  269 \nthe ex pen se  o f non -w hit e peopl e  [56] r ega r dl e ss o f coloni al ro ots [95] . Whil st t his rev iew  u se s t h e  270 \ndec oloni sing glo bal  he alth  te r m inology  througho u t , a s thi s wa s re fl ect ed in  th e sea rc h t erm s a nd  271 \nmajo r ity  of th e lit era tur e, f urthe r ex plo ration  of w hat  ot h er  termin olog y is  u se d is  includ ed i n t h e  272 \ndiscu s sion .  273 \nW h y  de c o lo n is e  g lo bal  h e a l t h?  274 \n 275 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n13 \n \nAt t he h ear t o f why autho r s  adv oca te that gl o bal he alth mu st be  de coloni se d is the b r oa d  a nd  276 \nco ns i st ent under standi ng tha t while c ol onis ation i s l argely  a re mnan t o f th e pa s t , th e her itage a nd  277 \nleg aci e s  of c oloni a lis m ,  s uc h a s poli ti ca l and ec onomic  s t ructu re s, he al t hc a re sy stem s, pow er  278 \ndyn amics, beha viou r s  and  pa r t ner ship i nequiti e s continu e to perme a t e  a c ro ss, and be entr enche d  279 \nwi t hi n, globa l hea l th [7, 10, 11, 41, 54, 5 8,  66, 75,  77, 84 , 87, 9 6-99] .  280 \nThe  c olonial  le gac y ha s c on tr ib u t e d to the g ap in h ealth outcome s  [60 ] a nd li fe expec tancy  [10 0]  281 \nbetwe e n high and low  in come c ou ntr i e s.  O n e e nduring p roblem  i s t hat  th e d e faul t pa tien t in  t h e  282 \nhea lthca re fiel d  is o ften c on sider ed t o b e a w hit e mal e, the re fore  decol oni s i ng sy mptoms, s ig n s  a n d  283 \ninv es t ig ation s i s  an im portan t pa rt of w hy  d ecolo nis i n g globa l heal th is n eed ed .  F or instanc e , wh it e  284 \nEuropea n bioc h emica l and v is u al norm s u s e d u niver sally  can i ncrea se th e risk o f misdiag no s i s ac r o ss  285 \npopul ati on s  [ 9 6 ].  286 \nAs such, the a r g ument for d ecol oni sing  global  hea lt h c ome s  fr om the imp era t iv e to hold act or s,  287 \nfunde r s and ena b ler s  i n globa l he alth p r ogramme s  ac cou nt a bl e f or th eir (in )acti on  [43 ], and a dd r e ss  288 \nongo ing pol it i cal manipul a tion , hyp ocri sy and distru st [1 01 ] in ord er t o red efi ne  r o l es  in in te rnati ona l  289 \npartn er s h ip [59] , an d r e d r e ss injus tice s a n d improve heal th eq ui t y  [61, 1 02] .  290 \nThe  a n s w er to th e q ue s ti on o f ‘w hy dec olonis e gl obal h ea lt h now?’  h a s  b e en s h a ped by th e C OV ID -291 \n19 pande mic in the liter atu re. A  numb e r  of au thor s  empha si s e s the impor tan t r ol e th e CO VI D-1 9  292 \npand emic ha d in highl igh ting ine qui tie s i n global  heal th ou tcome s , pa r tn er ship s  a nd t h e deliv er y  o f 293 \nglo bal heal t h pr ogramm e s , a nd the refo r e unde r li ning th e need  t o dec oloni s e globa l heal th [71, 84 ,  294 \n103,  104].  295 \nAppro ac he s to dec oloni si ng g l obal h eal th   296 \nFrame work s, a s a  mean s  o f un der s t a ndi ng the  ne ed to  decol oni se  glob al  h ealt h and  a s a n appro ac h  297 \nto pu t a d ec oloni sing a p pr oa ch  into  ac ti on were  i den tifi ed in a n umbe r o f t h e  p aper s  i n our  s earc h .  298 \nAmongs t the pape r s inc lud ed in  th e  mo re  re cent  o f ou r two se arc he s (S ept embe r 2024),  we n ot ed a  299 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n14 \n \ngreat er emph a s i s on t h e  a pplic a tion an d ac t i on in t he  frame wo rks a nd app roa che s  id en t i fie d t ha n  300 \namon gst the pa per s  id enti fied e arli er [24 , 38 , 39, 1 05-107] .  301 \nThe  fr amew ork s  a nd a pproach e s  set ou t in th e pap er s w e inc lude d sh are  o verl appin g t h em es a nd  302 \napproa ch e s. The se incl ude utili sing an e pist emic  i njust ic e fram ework,  a  foc u s o n ‘true’ pa rtn er s hi p  303 \nwork ing, rethi nking  the struc t u re o f glo bal  he al th, con sid ering indi vidual  du tie s , along s ide  a c tion s  304 \nthat c u t  acro s s  a ll th e se app roac he s .  305 \ni)  Epi stemic  inju s tic e  306 \nThe  e pistem ic inju stic e f r a mework a pp roa ch foc u s e s on c ount er i ng t e s timo nial i nju s tic e , s p e cific ally  307 \nwhe r e  l oc al e xperti se  i s  ex clude d fr om re se arch and l o cal know le dge p roduc tion i s de emed  a s  308 \nill egitimat e or le s s e r. I t al so fo cu s e s  on c ounter i ng interp r e t i ve injus tice by  u s in g  l ocal  in t e r pr etiv e  309 \ntool s and e n s u ring  r e s e a r c h aim s a re not s ole ly a ligne d t o t h e  domina n t  we st e r n audienc e [45, 61] .  310 \nThe  importa nce o f l oc al k nowle dge an d contex t  i s  c on s i s ten tly hi ghligh t e d  [84 ].  Avoidin g judge ment  311 \nbas ed on  for e ign c ul tur a l  norm s  and u sin g i ndigenou s  driv e n le a dership  [ 2 9 , 39, 6 9, 75, 1 08, 109 ]  are  312 \nke y to this . Loc al ex pert incl u s ion  s houl d be app r ec ia ted [24 , 38, 50 , 51, 84]  n ot  jus t b e see n a s a tick  313 \nbox  [20] and t he re  shoul d be r ec iprocal  k nowl edge fl ow [5] .  314 \nThis can  be  don e through  men toring,  i nve s ti ng in re se arche r s a n d a gr eeing pr ioritie s  lo call y [ 1 9 ].  315 \nBuild ing up  loc al  e xper ti s e  and s upp orting  ex isting  pr ogramme s in  LM IC s  ra t her than d e signing  316 \nprogramme s aro und th e need s o f w e stern st u d ent s  i s a way  to s hif t  the loc u s  of co ntrol [22 , 109 ,  317 \n110]. Lik ewi se, me dic al journal s sho uld  d iversi fy th ei r  bo ard s  [19] , a s  th e ga te keepe rs o f globa l  318 \nhea lth  know ledge . Loc al i ndige nou s  kn owl edge can  and sh ould b e r e-l eg itimi sed  [30, 73,  10 8] ,  319 \nthrough r efl ection  on th e te rminology  us e d w hen di s c us s i ng  g lobal hea l t h  c hal le nge s [9,  11 1 ] a n d  320 \nmak ing r oom  for al te rnat e epi s t e mic standpo in ts [6,  112 ]. Th ere  s hould al s o  be equ ity in d a t a  321 \nco llec t io n,  anal y s i s , u sag e  and st oring [2 9, 45] to en su re al l par t ne r s  hav e e qui t a ble ac ce s s, a s wel l a s  322 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n15 \n \nthe inc lu s i o n o f r epre s enta tive  p a r tic ip a nts  a nd r e s e a r c he rs in c linic al tr i a ls , whi c h o t he r w ise  l e ad s 323 \nto a d ep endenc e upon clini cal  guidel in es fr om  H I C  s et ting s [51 ].  324 \nii)  Part ner shi p w or k ing  325 \nPar tner s h i p w orking is r e la ted to e pi ste mic  injust i ce a pproac h e s a nd fo r m s a f un dament al par t o f  326 \nhow  the li t e r a t u re sugge s t s  ap p r oa ch ing  de colon i s ing  global  he al th, par ticula r l y in ac ad emic  327 \npartn er s h ip s . P artne rs s h ould hav e sha red dec i s io n makin g with st r a te gic pr io r itie s  a nd  328 \nimple menta tion driv e n by t ho se t ru st e d  by a ff e cted gro up s [86, 113 ].  329 \nFun dament all y, th e  loc u s  o f c ont rol sh ould s i t  with l oc al i n s ti tuti on s ra ther  tha n ‘e xper t’ for eig n  330 \npartn er s  [38 , 114 ], abi ding by  t h e  princi pl e o f “no  r e se arc h a bou t us , with ou t u s ”  [1 2, 115 ]. Thr oug h  331 \npartn er s h ip wo rking , communi t i e s an d g lobal he a lth  pr a c tition er s b a s e d i n LMIC s s h ould  b e  332 \nempow ered to shap e g lobal he alth in te r ve nt i on s  [ 2 2 , 89, 1 09, 116 ].  Thi s is a c ont r a st t o glo bal he a lth  333 \nh i s to r ic a l ly  w h er e g l o b al h e a lt h  ex p er t is e h as  b ee n  co n ce n t ra te d  in  l e g ac y  po wer s  [ 8 7 ]  a n d c on c e r ns 334 \nabou t  the c ur r e n t  s truc ture of glob a l he alth r efl ec ting ‘ feud al powe r ’  [ 7 7 ]. Thi s i s  beca u se fundi ng i s  335 \nsugge st ed to favour  HI C s w ith  no  dire ct fu nd ing t o LMI C s, in ste ad u s i ng ‘f eu da l i nte r me di arie s ’  336 \nther eby ret ai ning pow er within t he hi e ra r c hy of the fe uda l s t ruc tu r e .  D a ko e t al [ 24 ]and Kuma r  e t a l  337 \n[105]  ca ll fo r  r e sea rch funding  to b e m ore equit ably  di s t ribut ed,  fo r  gr ea ter fu nder acc ounta bili t y  338 \nand a n e nd to the  dono r-d riven mod el .  T his w oul d en tail tha t funding a lway s  i nc ludes  i n s ti tuti on s  339 \nrath er th an be s t ruc tu r e d aroun d l oca l partn er s  bei ng used a s s u b -gran te e s ,  and t r ea t m e nt  o f 340 \nre sea rcher s s houl d b e the s a m e r e gar dl es s  o f th eir origin [95] .  Na s s iri -An s ari e t  al [88] co ncu r tha t 341 \ngreat er Sou th -Sou th coop e r a t io n in the  f o r m o f fundi ng a nd n ew funding mo dels  tha t  favou r  o f  342 \nmultila te r a li sm ove r  b ila teral  arrang e ment s , op era te wit hout s tipula tion s, an d  re spond to loc ally  343 \niden t i fi ed n eed s w ould “ shif t pow er from  dono rs t o th e do er s ” .  344 \niii )  Structure o f glo bal  h ealt h  345 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n16 \n \nMany  appr oac he s to de coloni s ing  gl o b al h eal th a l s o focu s on  re thinking  the s t ructur e o f glo ba l  346 \nhea lth . This c an inc lud e re thinki ng and r estruc turing  g overnanc e rela tion ship s t h a t s hape  d e cisi on s  347 \n[12, 46, 69,  10 4, 116] r i gorous  an a lysi s of powe r  a symme t ri e s [117] and no t arb it rary  mov ement s  348 \n[11] , and  reb uildi ng r e sea r c h  infr a s t ruct ure f r om the g round u p [10 ] . Kwet e e t al. [71]  argue  th at  349 \naddre s sing str uc tur a l i s s u es in glob al  hea lth requi r e s de col oni sing  the poli tic al e co nomy  first.  350 \nT h i s  r a i s e s  t h e  q u e s t i o n  o f s ys t e m i c  i s s u e s  w i t h  h o w  g l o b a l  h e a l t h  i n t e r a c t s  w i t h  t h e  a i d  i n d u s t r y .  To  351 \ndec oloni se  global  h ea lt h it  i s  s u gge st ed  tha t thi s ne ed s t o s ta rt  w ith d e bt c a n cel lation  and non -352 \nearma r k ed budget supp ort [44 ] ,  f a ir a llo ca tion o f r e s ou rce s  [66 ], b road en ing me thod s of educa t i on  353 \nand r e search ,  c hang ing  te ac hing for  we s ter n  stud ent s [22 ,  84,  110]  cha nging  the  l ocati on o f w h er e  354 \nglo bal heal th educ a t i on h ap pen s  [56 ], r ed ucing  th e r e li anc e o f H I C s he alth se rvic e and r e s earc h  355 \ninst itu t i on s  on  t a l ent from LM IC s [51 ], stop ping the  “ brain drai n”  o f h e a lt h  w o r k e r s  fr o m  L M I C s  [ 5 1 ] ,  356 \nand rei magini ng glob a l he alth a s social  medic ine [118] . The re  a r e  al s o s ug ges t io ns  on  how  to  t a ckl e  357 \ndec oloni sing glo bal  he alth  in aca demia through dive rsity in  au thor s hip  [97 , 11 9], en suring p ape r s  358 \nhav e multili ngual ab strac ts [9] a nd inc lud ing study o f  t h e pl ac e it sel f a s pa rt o f th e  w or k  [79].  359 \niv)  Indi vidu al  du ty 360 \nThoug h much o f the f o cu s  on  a ppr o a ch es  to  de col oni s ing  g lobal  he a lth  i s  syste mi c and struc t ur al ,  361 \nsome li tera ture  doe s highlig ht a n indiv idual ’ s  power t o c hange thing s. Pr a c titi oner s ar e a sked t o  362 \nrefl ec t  an d que st i o n in sti tut i onal and s tr u ctu ral p rac tice s a nd n ot t o  ac t  b eyo nd thei r e xper ti se  363 \n[110] . Thos e enga ging in dec olonisi ng glob al healt h initiativ e s should be r ewar ded for t h e ir  e ff ort  364 \nand r i sk in sp eakin g ou t [86]  an d n ot ac c epting  t he  statu s  quo [110 ] .  Thi s ca n con tribut e to bui lding a  365 \nc ul t u r e of r ef l e x i vi t y  b y  s p a r ki n g  d i al o g ue  in  i n st it ut i o ns ,  wi th  t he  a i m  o f res u l t i ng  i n  c o ll e c t i ve  a ct ion 366 \n[120] .  367 \nIt i s  cle ar  t h a t wi th such v a rying sy st emi c , struc tural  a nd i ndiv idual i ssue s , d ecol onising  glo bal h ea l th 368 \nwi ll not h appen  qui ckly  or smo othly .  Th us  fa r t her e ha s  be en a  hig hlighting  o f  t he ne ed for c hange  369 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n17 \n \nand thi s is a ste p in the right dir ection .  “When w e make  vi sibl e thi s  imp licit id e ol ogic al fu nc tion tha t  370 \nthe gl ob al heal th fiel d per for m s, we  can  see new  dir ection s , new  idea s a nd new  allies for colle ctive  371 \nac t i on tha t ar e o therwi se k ep t u nima gi n able”  [121 ] . Thi s  is  a spira tional ,  but a l s o  r eq uire s  a  pa thway  372 \nt o  s u c c e s s  w i t h  a c t i o n - g u i d i n g  s t e p s .  T h e s e  c o u l d  i n c l u d e  a  c o m m i t m e n t  t o  a  c l e a r  l i s t  o f r e fo r m s  t o  373 \naddre s s dec ol oni sing glo bal heal th with  metrics to tra ck the pr o gre ss o f t he se  ref o rms [6, 98] to  374 \nens ure any  ac t i o n i s acc ounta ble.  375 \nBarriers  t o D e colo ni s i n g Gl oba l Hea lth  376 \nImple men tatio n of de col oni s ing  g lobal hea lth fac e s mul t i f a ce ted bar rie rs  r oot e d in bot h  hist orica l  377 \nleg aci e s  a nd co nte mpora r y  dyna mics.  378 \nOne c ritica l  hurdl e  i s  t h e  n e glec t ,  at  t h e i ndividu al  level ,  t o  “e m ancip a te a n d d ecol oni se  o ur ow n  379 \nmind s  ( fr o m t he  c oloni al condi t i o ning s o f o u r  ed u catio n)” , a fund ament al s tep ofte n o verl ooke d i n  380 \nthe di s c our s e . Acc ording t o Abimbol a  et a l [55 ],  col oniali sm soug ht  to in fil t r ate and manipul a te  381 \nfundam e ntal huma n v alue s, w ith t h e  coloni al cl ass room ser v ing a s  a m ea ns o f p s y cholog ica l  382 \ndomina tion  in Af rica a nd o the r re gion s.  They  s ug ge st that  th e li ng ering ef fec t s  o f c olo nial  educa t i on  383 \npoli cie s ha ve ins til led a  s en se of in feri ority in  many  indi vidual s , highl ighting the urge nt  ne ed t o  384 \ndisman tle t hi s  m ind s e t  and r ec laim a u tonomy ov er  our perc e ption s and jud g ments.  Fa il ur e  t o  385 \naddre s s t h i s  a s p ec t imped e s  progr es s by perpe tua t in g ent rench e d ideol ogi es a nd p ower imba lanc e s.  386 \nA r a ú j o  e t  a l  [ 5 0 ] ,  F a r a g  [ 1 2 2 ]  a n d  G e d e l a  e t  a l  [ 1 2 3 ]  b e l i e v e  t h e  u n d e r v a l u i n g  o f s c i e n c e  p r o d u c e d  i n  387 \nL M I C s ,  p a r t i c u l a r l y  b y  g l o b a l  h e a l t h  l e a d e r s ,  i s  b o t h  a n  a r e a  t h a t  t h e  e p i s t e m i c  i n j u s t i c e  a p p r o a c h  t o  388 \ndec oloni sing gl obal  heal th se eks  t o  add re ss , a nd  a n o ngoing ba rrier  to de colon i s ing  g lobal  hea l th .  389 \nThe  pe rs i s tenc e  o f such  a ttitu de s ri s k s  r ei n for c ing d i s pa r i tie s  a nd hi ndering  the  int eg r a tio n o f  390 \nco nt e xt - s pec i fic  s ol u t i on s  i n t o global  he a lth i nitia tive s.  391 \nMoreove r, a  domina n t  p er spec tiv e i n t he lit era tur e s ug ge sts t ha t  dec ol oni sati on e f forts oft e n  fal l  392 \ns h or t  in  a d d ress i n g w h a t  is  p er ce i v ed  as  t h e r oot  ca us e  of co l o n i a lit y:  w h it e s u p r em ac y .  A cc o r d i n g t o 393 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n18 \n \nB i n ag w a ho  et  a l [ 5 6] , t he  g l o b a l i n fl ue n c e  of w h it e  s u p re m a cy ,  r o ot e d in  g e o gr a phi c  d is t i n ct ion s  an d 394 \nskin colou r di s pa r i t i e s , pervad e s  variou s socie t a l dom a in s worldw ide . Add r e ssi ng its  p r e s e nc e i n  395 \nglo bal he a lth  educa t i on i s c rucia l,  a s i ts eli mination  c ould  pro foundly  bene fi t t he  hea l t h  a nd we l fare  396 \nof ma r g in alized p opula tion s g loball y . B ina gwa ho et  a l [56]  and F inke l  e t a l [ 97] argu e th at t he  397 \nex is ting  g lobal h eal t h di scou rse in ad equ at ely confr ont s t he ongoi ng mani fe sta tion o f  wh ite  398 \nsupre macy , particul a r ly  evide nt  in le ade rs h ip in equiti e s where wh ite  me n fr om HIC s do mina te key  399 \nposi tion s and dec i s io n - m aking  power is conc entra t e d in H I C s . Thi s  la ck of div ers i ty i n s eni or  ro le s i s  400 \nex ace r ba t e d by c onfu s i on abou t the me a ning o f  decol oni s a t i on a s oppo sed to inc l us i on and di ver s i t y  401 \n[86] .  402 \nYerramil li [44 ]  al so  argu e s th at  t he  suc c ess o f th e decol on i s in g g lobal  hea lth move ment ma y b e  403 \ndepe nd ent o n much w ider glob al fac tor s re lat ed t o deco lo nisi ng the wo rld' s  pol i t i cal e conomy . Thi s  404 \nentai l s  di sma ntling  t he d ee p -sea ted  soci o - e co nomi c inequi tie s  exa cerba ted by  hi s t orica l  405 \nco lonis ation . Yer ramill i argu es tha t deco l onis i ng glob a l heal t h r equi res us t o c hal l enge our c onc ept s  406 \nof ‘aid ’ , a s  thi s implie s volu n t a r y  rel ie f, and ‘s ustain a bility’  a s  t hi s i gnore s th e o ng oing poli t i cal a nd  407 \nec onomic  oppre s sio n o f dev el oping  c ou ntrie s.  Rei magini ng t h e  g lobal politic al ec onomy along s id e  408 \nfinan cial  c ompe ns atio n for cou ntri e s’ hi s t oric al and ong oing ou tfl ows i s ne eded  to tr ul y decol on ise  409 \nglo bal he al t h  [4 4 ] a nd  th e over arch ing i nflue nc e o f the  wo r ld' s  pol i t i cal  e conom y  all c omplic a te t h e  410 \npath to d ec oloni sing glob a l h e alth  [ 10 , 43 ]. Fi nally,  Hellow e ll 2022 a rgue th at w hil e th e  411 \ndec oloni sa tion agend a  ha s th e  pot enti al to stimula te a mu ch n e eded re di s t ri bution o f dec i s i on -412 \nmak ing p ower in global  heal t h,  it al s o  ha s  t he po ten tial to un dermin e c onfi denc e in  s c ienti fic  413 \nkno wledg e, acc entu ating  inte r g r o up an d  interna tional  an tagoni sm s and curt aili n g the opport uniti es  414 \nfor r edi st r ibutio n in the futu re [94] .  415 \nPers pec t i ve s fr o m low  a nd mi d dle i n com e econ omie s  416 \nA s  t h e  i m p o r t a n c e  –  a n d  l a c k  –  o f L M I C  v o i c e s  e m e r g e d  a s  a  t h e m e  i n  t h e  n a r r a t i v e  a n a l y s i s ,  w e  417 \ndec ided to highli ght th e per spec tiv es o f LMIC author s i n thi s s c o ping revi ew. Howev er, i t  mus t be  418 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n19 \n \nnoted that LMI C or i gin ating  pa p er s  gen e r a lly propo se  simil a r  co ncep ts a nd i de as w hen compa r e d  419 \na c r o s s  t h e  s p e c t r u m  o f p a p e r s .  T h e r e  a r e  s e v e r a l  r e a s o n s  fo r  t h i s .  M o g a k a  e t  a l  [ 1 0 ]  s u g g e s t  420 \nre sea rcher s fr om  LMI C s ar e educ ate d an d working  within or t owa r d  H I C  global  h ealth s tr uc tu r e s  a n d  421 \nsta ndar ds. Al so, t he proc ess by w hich w e identi fie d au tho rs  from LMI C s, by on ly refe rr i ng to pa per s  422 \nwhe r e  a u t h ors worke d fo r or g ani sa tion s ba s e d in L M I C s, may  mi ss o r  ex clude  tho se au thor s  fro m  423 \nLMIC s who  ma y now r e side  in H IC s [ 6 8,  106]. It  may be  th at the  sea rch t erm s u sed  ha ve  iden tifi e d  424 \npubli cation s b y a uth ors who s h are  s i mi lar pe rspec tive s . An d fi nall y, the s e  pap er s ha ve not  bee n  425 \nrevie wed i n i sola tion a nd a re al s o e mb ed ded w ithin th e a bove n ar r a tiv e.  426 \nA part i cula rly  st r on g c once r n  from L MI C autho rs discu s s ed t he di spari ty o f  f u nding  a nd e xperti s e  427 \nwhi ch is perp etu ate d by the  c ur re nt s tr u c tur e s and  p r o ce s s e s  ope rati ng  acro s s g lobal h ealth  [10, 5 0 ,  428 \n56, 1 15, 120]. T here is a c lear dem an d for  pa r i t y  in partn er s h ip s  [10 , 31, 56] w it h loca l ex pert i se a nd  429 \nlea der s h ip rec ogni sed and utili s ed [31, 99, 115, 120], in a r e al rathe r than tok en istic  ma nner [76 ,  430 \n106,  124].  Thre e pa p ers de scri be the i m por ta nc e o f huma n fac tor s  in  d ecolo ni sa tion  [ 7 1, 120, 12 5 ],  431 \nhig hlighting  that cha nge wil l no t  h appe n w ithout th e s elf -re fl ection o f globa l h e alth pra ctiti oner s .  432 \nSha r ma  and  Sa m - Ag udu  [126 ] empha si se  th e pa rticul a r  n eed  for  p racti tione rs f rom  th e “Glo ba l  433 \nSou t h”  to ta ke ac t i on t o  d ecol on i s e g lob al he alth , a s t he  bigge s t stak eh older s an d tho s e  who s t a n d  434 \nto be ne fit the  mo st fr om d ecolo n is i ng  g lobal heal t h.  S syen nyonjo et a l. p r e se nt th e d e coloni s ing  435 \nag enda a s an oppor tunity that co uld be  l everag ed in orde r to ac hiev e s t rat egic  as pi r a t i o n s  de fine d  436 \nby Africa n s  them s e lve s [ 1 27 ], t h roug h Age nda 2063, a stra tegi c docum en t c r e ated by the  A frica n  437 \nUnion. [128]  438 \n 439 \n4. DISC USS ION  440 \n 441 \nIn thi s pap e r  w e h av e revie wed ex is t i ng l itera tur e ar ound th e t o pi c of d ec oloni sin g global  healt h a nd  442 \nrepor ted t h e r a nge of dif fe ren t d i s c ussi ons and vie w s. We ha ve foun d th at t h e  decolo ni s i ng globa l  443 \nhea lth mov emen t broadl y a ttemp ts to  define what deco lo ni s in g g lobal healt h is ,  ex plore pow e r  444 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n20 \n \nimba lanc e s  in curr ent glob al  hea l th st ruc ture s , and how  to addr es s  the se  i mbalanc e s. Our se arc h  445 \nshowed t ha t t h e majori ty of the li ter atur e a bout d ecol oni sing gl obal h eal th  is in t he  for m  o f  446 \nco mmentary or  o pini on pi e ce s, w ith a u t h ors ba se d in HI C s  domina t i ng, alth ou gh it i s  di ff icul t  t o  447 \nac curate ly  as s e s s eve ry autho r’ s  b ack gro und.  448 \nMuch  of t h e  lit era tur e de scrib e s th e hi s to r ic al o r ig in s  of  global  h ealth  th rough c o lonia l medic in e a nd  449 \natt empt s t o  de fine  de coloni s ing  globa l  h ealth  i n o rde r to  fr a m e t he d iscu s sion  on  de coloni sing  globa l  450 \nhea lth . Thi s th en he l ps  de fine w hy th e d ec oloni sing  globa l h ealt h m ovement i s  n ee ded a s a me an s to  451 \naddre s s epi stemic  inju s tice  and  red uce  hea lt h ine qu aliti e s. Our rev iew s ug ge s t s  t ha t  ther e i s no  452 \nuniv ersal ly ac cep ted d e fi nition  o f dec ol o nising gl ob al he a lth,  t h a t the re i s unc erta inty over  how  t h e  453 \nterm orig inat ed a nd i s u sed to fur ther  the  int ere st s o f H I C s,  and tha t th ere  i s a  que s tion a s  t o  454 \nwhe t h er it i s the  mo s t approp riat e r e spo nse t o t h e  in e quiti e s driv en  b y colon ia lism w it hin globa l  455 \nhea lth .  456 \nThe  li te r a t ure  inc lude d in  our  r e view  w as  g ene rally  con si s t ent  on  appr oac he s  t o dec olo nis e glob a l  457 \nhea lth wit h sugge stion s inc luding : emp o we r in g loc al c ommunitie s, inc r ea sing op portuni tie s for t ho s e  458 \nin L M I C s , ad d r e s sing epi s temic  imbal an ce s, moving  mor e  deci sion -ma king pow er into LM IC s,  459 \nc h a n g i n g  t h e  m i n d s e t  o f t h e  h e t e r o s e x u a l ,  w h i t e ,  E u r o p e a n ,  m a l e  b e i n g  t h e  d e f a u l t  r e fe r e n c e  p o i n t  460 \nfor me dical  p rac t i ce , and r e struc turing global  hea lt h so tha t lead e rship and st ructur es  a re more  461 \nrepr ese nt ative o f t h e  globa l commu nity.  462 \nDe spit e the cl ea r impera tive  in the lite ra ture to t ake  action , the re i s  no clea r  c onsen s u s on w her e to  463 \nsta r t a nd how , even  i f ma ny o f  the ac ti ons s ug ge st ed are s h a r ed  a cr o ss the li te ratur e. A s  we  n o t e ,  464 \npape rs ide nti fie d in the mo st r e cen t o f t he two sea rch e s  o f the l i tera t u re w hich  we unde r t ook  mor e  465 \nfreq uen tly pre se nte d ac tiona ble next step s.  Howe ver , w he re s t e p s ar e se t o ut (u sing data a nd  466 \nmetric s [6 ], sub sidiari ty and s ha r e d de c ision maki ng [1 29 ], ov erhaulin g th e gl obal health indu s tr y  467 \n[130] ) i t i s o fte n n o t  cl ear h o w t h e se s hould be  coordin at ed  an d  by  w hom. T his i s pot enti ally  a n  468 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n21 \n \noutco me o f t he  n as c ent na tur e of di scu s s ion s on how  to d ec oloni se gl ob al hea l t h  a nd fu r th e r  w or k  469 \non thi s may  be for thcomi ng.  470 \nThe r e a re  clea r  ba r ri er s to d ecolo ni s in g globa l heal th tha t ar e de scrib e d within t he li t e r a t u re . T here  471 \nis a r ec ogniti on  th at muc h o f th e i m balanc e st ems from t h e donor -r ecipi e nt rel ation shi p a s  a  472 \nco ns e qu ence  of how  aid work s in our cu r r ent g lo bal geop ol it i cal s y s t e m. Inde ed, s om e  473 \nco mmentat or s  highl ighted tha t g lobal  hea lth i n i ts cur ren t fo rmat i s pa rt  of the  p roble m,  474 \nentr enc hing imbal ance s and p owe r  dy n amics th r ou gh t h e  us e of aid a s s of t p o wer. Some au thor s  475 \nsugge st ed tha t the struc tura l cha nge s ne ede d ar e wi der t h an th e gl obal hea l th s y s t em a nd ex t e nd to  476 \nl o o ki n g  a t t he  g l o ba l  ne o- l i b er al  ca pi t al i s t s y st em as  t h e r oot  o f t hes e  i ne q ua l i t i es.  D es p it e  t he  477 \npreva iling c all for struc tu r a l chan ge s, th e r e  app ear s to ha ve be en limi ted e ff ort s to ad dr e ss t h e s e i n  478 \nmajo r  gl obal hea lt h institu tion s with onl y  a few ex ploring how  t h e chang e s i n pra ctice  s ugg ested  i n  479 \nthe li ter atu re ma y b e im plem ent ed. Non e o f t h e  pap er s id enti f i ed i n our re view  re por t ed t he  r e s ul t s  480 \nof c hange s or int erven tio n s  to imp leme n t any  s uc h c hange s in p r a ctice .  This may be due to a  t en s i on  481 \nbetwe e n th e s tr uctura l ch ange s cal l ed for  i n g lobal h e al th re lying on  c hange  to  be driv en by tho s e  482 \nlea ding tho se very g lobal hea lt h institu ti ons th at ar e ack nowle dged as pa rt of th e  p r obl em. Ind eed , 483 \nthe que s tion rem ain s, who is be s t  pla ce d to drive fo rwa r d th e s tr uc t ur a l chan ge s i n or d e r  to mak e  484 \nglo bal hea lt h more eq ui t a bl e.  485 \nIn te rms o f sp ec if ic a c tion s or  princ iple s to dec ol oni se globa l h eal th, ba sed on  th e p ape rs  a ppra ise d  486 \nin thi s  revie w, we p ropo se th e foll owin g a s  a star ting point to furthe r  the di s c u ssion. Th e se a r e  487 \norien tat ed by the  same co n ceptu al cl a ssific ation  we s aw  i n  t he li te ratu r e  on dec oloni sing globa l  488 \nhea lth .  489 \nRec ommended Approache s  490 \nEpi stemic  inju s tic e  491 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n22 \n \n1.  While i t  i s  u se ful to hav e a sh are d termi nolo gy an d understan ding in orde r to pr omote go od  492 \nprac t i ce, thi s doe s  no t hav e to be fr a m e d as  ‘d ec oloni s ing  global  h eal th’ . Alt ern ative te rms  493 \nfrom LMI C global  hea lth a ct or s  should be  co ns ide r e d .  494 \n2.  Aca demic  tool s, s uc h as qu ali ty as s ur an c e fr a mework s, s ho uld be r e -e nginee re d to ensu r e  495 \nthat they r e fl ec t and  conv ey a  varie ty of  epis temic view point s.  496 \n3.  Global h ea lt h re s earch , fundi ng, edu ca tional a nd lea der s hip  oppor tuniti e s  s houl d be  497 \nprioriti se d for  globa l h eal th ac tor s from  LMIC s to addr es s th e impor tanc e  o f  lo c al con t e x t  498 \nand knowl edge in dec i s i on -making .  499 \n4.  Global h e alth ac t or s, in s t i t u tion s and  funde rs s h ou ld ac knowl edge th at ex pert i se a nd  500 \nkno wledg e exi sts and mus t  be con sid ere d i n t h e wide s t r ange o f f o rms tha t may i nclude  t h e  501 \nliv ed exp erience , loca l, cult ural,  poli ti ca l and traditi onal  knowl edge of ind i vidua ls  a nd  502 \nco mmunitie s.  503 \nPart ner s h i p wo r k ing  504 \n1.  T h er e  is  a  d u t y  fo r  g l o b al  he a lt h  a ct ors  t o  i mp l e m e nt  a n d  e va l ua t e  s ha r e d  de cis i on  ma k i n g 505 \nframew o r k s  a n d proce s se s  in glob a l hea l t h  coll abor ation s .  506 \n2.  Global h ea l th a cto r s  s h ould adopt a  minimum st a ndard to work  towa r d s eq uitabl e  507 \npartn er s h ip s , en suring ma teri al and h u man r e s ourc e s  ar e e qui tably  av aila ble to all tho s e  508 \ninv olved.   509 \n3.  When b r ok ering a nd ev aluating  glob al  pa r tn er ship s, glob al h ea l th ac to rs sh o uld i nclude  510 \na ss e s s m en t  of t he  eq u i t y  of t he  p ar tn e rsh i p . 511 \nStructure o f glo bal  h ealt h  512 \n1.  The r e i s a  ne ed t o  gene r a te  int erven ti ons a nd me t ric s  to s u pport t h e d ec olo nisa tion o f 513 \nglo bal hea lth . Thes e sh ould an swe r  que stion s such a s ‘How d o we k now h ow ins ti tuti on s  ar e  514 \ncu r rently  perfor min g? ’ or ‘ Ho w do w e kn ow that an in terve ntio n ( e .g. dec oloni s i n g  a learni n g  515 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n23 \n \ncu r ric ulum) ge nera te s  t h e  int end e d o utcom e a nd d o e s  n o t acc entu ate harm .’ The re is a nee d  516 \nfor met hodolog ical  inqui ry and  deliber at ion to think  abou t wha t  me t ric s  w ould b e v alid an d 517 \nhow  progre ss s hould be  me as ured .  518 \n2.  Fi nanci al a id flow s  from HI C s  to L MIC s s hou ld be  ta rget ed t ow ard s  LMI C re sea r c he r s  or  519 \nLMIC -l ed co llab ora tion s.  520 \n3.  The r e should be inc re a s e d di ver s i t y  a nd activ e rep r e s ent ation from acro s s  LMI Cs in globa l  521 \nhea lth l eade rship po siti on s.  522 \n4.  Wher e organi sa tion s com mit t o de col on i s ing  global  heal th, sys t e m -wide, o r g a ni sa tional a n d 523 \nindi vidual  acc ountabili ty  mecha ni s m s sh ould be em bed ded t o en sur e recomme n dation s a re  524 \naddre s sed and a ction s a re e valu a ted .  525 \nIndi vidu al  du ty 526 \n1.  Refl ec tive p r a c tice in globa l h ealt h sh oul d be  matche d with p ee r  di a logue  an d in sight d rive n 527 \nac tion to b et ter s u pp or t c ondi tion s wi t hi n organis atio ns to suppo rt  e ffo r t s to dec o lonis e.  528 \n2.  Global Hea l th act or s or t ho s e w orking i n or r e sea r c hing g lob al h e alth topic s shoul d a dvoca te  529 \nfor dec oloni sing g lobal hea lth t o ma ke v is ib le wha t  i s  at s t ak e.  530 \nThe se rec omme ndati on s ser v e , not a s a n end poi n t ,  bu t  a s  a p rag matic s tar t i ng point for furthe ring  531 \nthe di scu ss i on on how dec oloni sing gl ob al hea lt h  c ould be d riv en fo r w ard with a vie w to achi eving  532 \nmore equi table  outc ome s a nd  impa ct a cros s  t he sphe re o f g lobal he a lth . We t here fore  w elcome  533 \ndiscu s sion  and  critiqu e of th e s e ,  wi t h the hope  th at  comp iling th is di s pa r a te  lite rat ure  ai d s i n  534 \nrevea ling a cl ea rer pa th forward for thi s critic ally  importa nt move men t.  535 \nL i m i ta ti o n s  536 \nThe r e are som e cl e ar limit atio ns  a s socia t ed with thi s r eview . The  inclu sion cri te ria  focu s ed  on p aper s  537 \ndiscu s sing ‘de colo nis ing  global  heal th’ a s the p r im ary f ramework  ide nti fier for p a per s. Thi s may  have  538 \nbia sed the pap er s w e identi fie d and th e view s  that might be expr es se d i n tho se pap er s, a s  oth er  539 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n24 \n \nt e r m s  u s e d  ( p o s s i b l y  i n  i s o l a t i o n )  fo r  t h e  s a m e  c o n c e p t  m a y  n o t  h a v e  b e e n  c a p t u r e d  i n  o u r  s e a r c h  540 \nstrat eg y. A s  we  h ave see n, critic i s m s of t he  d ecolo n ising  global  he al th moveme nt  inc lude th e ide a  541 \nthat  t hi s i s  a  conv er s a tio n  tha t i s mo stl y b eing driven  by H IC s and m ay  now  be  bei ng u s ed  a s a  542 \nbuzz w or d  to d e mon s t rat e equi ty and jus ti fy  in sti tut i onal exi ste nce  in th e g lo bal heal th s pa ce to  543 \nfunde r s and poli t i ca l l eade r s. I t may a ls o  be  t h at s imi lar conv e rsatio ns a re oc cur r ing in t he  liter atu r e  544 \nwi t ho ut  u sing the sp ec ific term ‘dec olon ising gl obal hea l t h’  tha t w e have  n ot  th ere for e ca ptu r e d  i n  545 \nthis review .  546 \nIndee d, the A fr i ca C ent re s fo r  Di se as e C ontrol and Prev en tion, c ap tur e  a s i milar conc ept of ce n t ring  547 \nloc al comm unitie s, e n s u ring interv en tio ns  ar e loc al priori ty led and red uci ng the imbala nce of t h e  548 \ndonor -done e  r e la tion ship  [131 ].  Th e te rm t he y u s e for  t h i s  i s  ‘t he n e w publi c  he a lt h  o r de r  for  A frica ’  549 \nand th e t erm ‘ decol oni s i ng g lob al h eal th’ i s  n eith er u s ed no r pr eferre d.  Th is is  why  we ,  in ou r  550 \nrecom mended  appr oac he s, sugge st t h a t  an LMI C -le d c on se n s u s o n termin olog y is  impor tan t, bu t 551 \nthis termin ology  doe s not n eed  to  be dec olonis ing global  heal th.  552 \nThe  c once pt  o f a ‘new  public  he al th ord er  fo r Af r ic a’ may  h int a t  one  o f the w a ys  fo rwa r d for t h e  553 \ndec oloni sing g lobal he alth movem e nt . M o vement s t o  str ength en regi on al hea l th  or g ani sati on s suc h  554 \nas Afr i ca C DC and  the  ASE AN Cen tr e  f o r  Pub lic Hea l t h  Emerg enc ie s and Eme rgi ng Di sea se s  [132 ]  are  555 \nk e y .  T h e s e  o r g a n i s a t i o n s  e m p h a s i s e  t h e  n e e d  fo r  l o c a l  l e a d e r s h i p  o f p r i o r i t i e s ,  a n d  l o c a l l y  l e d  556 \ni n i t i a t i v e s  t o  e n s u r e  e q u i t a b l e  a c c e s s  t o  i n t e r v e n t i o n s  s u c h  a s  v a c c i n e s .   T h i s  m a y  b e  o n e  o f t h e  557 \ntangi ble w ay s tha t ou r r ecomme nded  ap proa ch to inc r ea sing L MI C l ead e rship a n d powe r  i mb alanc e s  558 \nwi t hi n globa l hea l t h  may b e mitiga te d.  559 \nIt i s al so  int ere s ting to not e th e t i ming o f  the p r ol i fera tion of li te ratu re on decol o n is in g glob al  hea l t h .  560 \nTw o signi fi cant eve nts could be a s s oc ia ted with thi s. F irs tly, the Blac k L ive s  M atte r  move ment i n  561 \nre spon s e  t o a numb er o f hig hly pu blici se d c ase s of U S  p olic e o ffic er s s h oo t i ng un armed blac k pe ople  562 \nled to  an i n crea s e in glob al awa r e ne ss  o f s oc ial ju s tice  with  peop le  w orking i n  d i verse  occ upa tion s,  563 \nrangi ng fr om h ea lth  to  educ a tion  [133 ] to e ngine e r i ng [134]  spark ing d ec oloni si ng move ment s  f o r  564 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n25 \n \ntho se s ec t o rs . S ec ondly, t he COVI D -19 pande mic sta r k ly demon s tr a t e d the  differenc e  in acc e s s  to  565 \ninterve n t i on s  a nd re s ourc e s  a vail able to diff e rent c oun tr i e s  [10 3, 104] , e sp ec iall y in term s of 566 \nper sonal pro tec tiv e equip men t, medic al trea tmen t and vac cinatio n s  [135 ].  C alls t o decol oni se globa l  567 \nhea lth o ft en h ighlig ht e d thi s ine quity a s  a d emon strati on of w hy the dec olon ising globa l hea l th  568 \nmove ment i s need e d.   569 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n26 \n \nAck nowledge ment s 570 \nThe  autho rs  w ould l ike to th ank  Anh Tra n,  Senio r  Kn owledg e and Evide nce Ma n a ger and  coll eagu e s  571 \nat th e UK Heal t h  S ec ur i t y  Age nc y Know ledge  and L ibrary S ervic e s  for th eir suppo r t and g uidanc e in 572 \ndev eloping  th e s earch st r a te gy for t his re vie w. 573 \nFundi ng  574 \nThe  autho rs  d id n ot r ecei ve fu ndi ng to a s si s t w ith the pr epar atio n of thi s ma nus c r i pt .   575 \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint \n\n27 \n \nReference s  576 \n1. Pan t, I.,  e t  a l., D ecol oni sin g glo ba l he alt h evalu ati on: S ynthe si s f ro m a sco pi ng r ev i ew.  P L O S  577 \nGlobal Public  Heal th, 20 22. 2 (11 ): p .  e00 003 06. 578 \n2. Pag e,  M. J.,  e t a l ., Th e  PRISMA  2020  s t ate me nt:  a n upd a te d gui de line  f or re porti ng  sys tem atic  579 \nrevi ews.  B MJ, 2021 . 372: p.  n71.  580 \n3. Arks ey, H .  an d L.  O'Mall ey , S copi ng  st udie s: tow ar ds  a m e th odol ogi cal fram ework .  581 \nInte rna tiona l J ournal o f S ocia l R e sea rch Me t ho d ology,  2005. 8 (1 ): p. 19 -32.  582 \n4. Munn, Z.,  e t  a l ., System atic  review  or  scop in g rev ie w? Gui da nc e for au th ors  w h en cho o s in g  583 \nbetw ee n a syste ma tic or scop in g r e vie w  app r o ac h.  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CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint","source_license":"CC-BY-4.0","license_restricted":false}