Decolonising Global Health: a scoping review

22 Thoug 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 co 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 re 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 dec 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 ex 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 move ment. 28 We 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 text 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 opini 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 eithe 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 and 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 pape 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 Inc 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 inc 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 the 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 dec 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 imba 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 addre s s t h e s e imbala nc e s. 40 De 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 sta 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 and 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 the struc ture of glob a l hea l t h , and i ndivi dua l duty. 44 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 3 1. INTR ODUC TION AND BACK GR OUND 45 Global 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 wha 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 to 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 injustice s. 49 A 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 ag 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 perpe 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 Thoug 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 revie 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 dec 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 co 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 and 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 iden 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 look ing to tak e a d ecolo ni s in g app roac h. 59 Our s pec i fic aims wer e t o : 60 a. 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 b. 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 dec 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 ch alleng e s t o a nd oppor tuni tie s for ac t i o n on thi s age nda ; 64 c. 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 dec oloni sing global he alth . 66 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 4 2. MET H O DS 67 We 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 revie 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 Sc 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 defini 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 http s : / /o s f.io /ynpk f/ 72 Eli gibility criteria an d se arch s tr a te gy 73 Any 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 and 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 re st ric t i on s o n public a tion da t e app lie d. 76 Pap 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 how 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 O 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 on 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 g 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 a 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 we 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 s 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 hea ding s, ti tle s and tex t word s . 85 We 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 litera 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 piec 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 using 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 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 5 [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 two p oint s , the fi rst in S e ptemb er 2022 a nd the sec ond in S ept ember 20 24. 91 F 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 suppl emen ta r y mate rial. 93 Sc reening 94 Se 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 re 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 title 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 using 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 inc 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 ex 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 referra l to a third a u thor. 101 Dat a ex t rac tio n 102 Dat 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 inst 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 co 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 fur 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 dispa 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 Dat a syn the si s 108 The 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 pre 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 also 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 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 6 As 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 wa 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 also 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 dec 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 may 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 et 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 publi 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 ev 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 Ins 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 inc 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 Narra 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 st 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 tool 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 The 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 ana 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 dist 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 defini 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 approa 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 inc 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 ga ps , op portuni t i e s a nd fu ture re s e a r c h. 131 Tabl e 1: Summ ary of all p aper s inc luded in t he re view 132 [T A BL E 1: Summary of all p aper s includ e d in the rev iew ] 133 3. RE SU L TS 134 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 7 Ele 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 ci 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 text 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 Fig 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 [FI GURE 1: P RISM A Flo w Diag ram ] 139 The 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 pape 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=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 d 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 Cana 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=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 in 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 Who i s talk i ng a bo u t d ecol oni sin g glo b al hea lth ? 147 The 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 co 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 hea 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 [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 H 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 [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 glo 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 regardin g equi ty - d riv en fun ding [43 ] and globa l politic al ec o nomy [44] . 155 Deco 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 data [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 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 8 fello 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 critique . 159 Fi 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 lea 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 p a r t ne rs hi ps [ 6 6, 6 7 ]. 162 Wha t is the g e ogr ap hica l dis tr ib uti on o f aut hor s? 163 De 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 (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 show 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 produc 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 LMIC (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 in 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 3 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=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 LMIC 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 c 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 a 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 showing 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 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 regardin 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 a 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 LMIC au thor s , a r e expl ore d in th e fol l owing narrative a nalysi s . 179 180 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 9 Fig 2: L ocation of the a ut hors contributing to pape r s inc lude d in th e rev iew* 181 [ 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 * 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 the time of public a tion . 184 Fig 3: L ocation of the first author o f pap ers w it h multiple authors i ncluded i n th e review ** 185 [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 ** This d ata o nl y inc lude s pape rs wi t h m or e th an one au thor . 187 Not 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 The legac y o f colo ni al he al th 189 The 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 and 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 16th 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 mis 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 co 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 s 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 [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 admi 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 In 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 under 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 usually 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 hav 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 pos 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 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 10 demon 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 socio 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 For 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 inst 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 The 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 tropica 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 underpin 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 prac 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 i 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 inst 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 m 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 bia 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 re 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 be s een throug hou t th e projec t cyc le o f ma ny g lobal h ealth pr ogramme s . [81 ] 216 By 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 ex 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 pow 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 impose d [44 ] . 220 Defi nin g th e dec olo ni s i ng gl ob al he alth mo vem e nt 221 The ‘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 co 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 leg 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 and 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 things , 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 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 11 asymme 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 glo 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 its 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 per spec tiv es [8 3, 84 ]. 230 Clea 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 co 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 and 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 approa 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 h 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 equa 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 indi 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 ste 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 inter 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 inter 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 on bo t h r a c e a nd gend e r equ ality [88 ]. 241 Howev 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 [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 "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 underd 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 The 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 Cont 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 co 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 one- 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 of 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 wi t ho ut rep r e s ent ation from suppr e s s ed minoritie s [92] . 251 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 12 Bey 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 deba 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 Some 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 8 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 rece 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 40]. 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 rheto 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 hea lth s i tua t i o n in Gaz a and t h e We st Ba n k [93] . 259 Hellow 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 wi 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 whi 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 pla 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 aim 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 ac 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 progre 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 Bina 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 a 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 as 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 the 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 dec 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 majo 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 discu s sion . 273 W h y de c o lo n is e g lo bal h e a l t h? 274 275 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 13 At 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 co 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 leg 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 dyn 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 wi t hi n, globa l hea l th [7, 10, 11, 41, 54, 5 8, 66, 75, 77, 84 , 87, 9 6-99] . 280 The 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 betwe 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 hea 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 inv 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 Europea 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 popul ati on s [ 9 6 ]. 286 As 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 funde 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 ongo 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 partn 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 The 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 19 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 pand 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 glo 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 , 294 103, 104]. 295 Appro ac he s to dec oloni si ng g l obal h eal th 296 Frame 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 to 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 Amongs 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 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 14 great 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 amon gst the pa per s id enti fied e arli er [24 , 38 , 39, 1 05-107] . 301 The 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 approa 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 work 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 that c u t acro s s a ll th e se app roac he s . 305 i) Epi stemic inju s tic e 306 The 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 whe 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 ill 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 tool 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 The 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 bas 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 ke 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 box [20] and t he re shoul d be r ec iprocal k nowl edge fl ow [5] . 314 This 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 Build 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 programme 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 , 317 110]. 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 hea 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 through 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 mak 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 co 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 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 15 the 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 to a d ep endenc e upon clini cal guidel in es fr om H I C s et ting s [51 ]. 324 ii) Part ner shi p w or k ing 325 Par 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 how 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 partn 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 imple 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 Fun 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 partn 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 partn 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 empow 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 h 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 abou 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 sugge 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 ther 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 [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 and 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 rath 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 re 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 great 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 multila 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 iden t i fi ed n eed s w ould “ shif t pow er from dono rs t o th e do er s ” . 344 iii ) Structure o f glo bal h ealt h 345 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 16 Many 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 hea 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 [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 [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 addre 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 T 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 dec 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 earma 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 and 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 glo 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 inst 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 and 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 dec 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 hav 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 iv) Indi vidu al du ty 360 Thoug 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 some 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 refl 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 [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 and 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 c 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 [120] . 367 It 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 wi 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 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 17 and 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 the 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 ac 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 t 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 addre 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 ens ure any ac t i o n i s acc ounta ble. 375 Barriers t o D e colo ni s i n g Gl oba l Hea lth 376 Imple 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 leg aci e s a nd co nte mpora r y dyna mics. 378 One 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 mind 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 the 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 fundam 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 domina 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 poli 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 disman 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 addre 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 A 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 L 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 dec 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 The 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 co 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 Moreove 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 s 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 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 18 B 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 skin 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 glo 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 of 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 ex 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 supre 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 posi 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 ex 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 [86] . 402 Yerramil 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 depe 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 entai 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 co 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 of ‘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 ec 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 finan 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 glo 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 path 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 dec 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 mak 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 kno 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 for r edi st r ibutio n in the futu re [94] . 415 Pers pec t i ve s fr o m low a nd mi d dle i n com e econ omie s 416 A 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 dec 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 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 19 noted 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 a 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 re 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 sta 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 whe 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 LMIC 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 publi 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 revie 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 A 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 whi 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 56, 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 lea 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 , 430 106, 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 hig 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 Sha 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 Sou 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 to 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 ag 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 by 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 Union. [128] 438 439 4. DISC USS ION 440 441 In 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 repor 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 hea 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 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 20 imba 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 showed 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 co 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 ac curate ly as s e s s eve ry autho r’ s b ack gro und. 448 Much 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 att 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 hea 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 addre 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 univ 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 term 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 whe 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 hea lth . 456 The 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 hea 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 in 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 c 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 for 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 repr ese nt ative o f t h e globa l commu nity. 462 De 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 sta 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 pape 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 freq 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 metric 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 [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 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 21 outco 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 on thi s may be for thcomi ng. 470 The 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 is 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 co 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 co 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 entr 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 sugge 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 l 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 preva 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 majo 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 the 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 of 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 betwe 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 lea 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 the 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 glo bal hea lt h more eq ui t a bl e. 485 In 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 in 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 orien 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 hea lth . 489 Rec ommended Approache s 490 Epi stemic inju s tic e 491 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 22 1. 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 prac 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 from LMI C global hea lth a ct or s should be co ns ide r e d . 494 2. 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 that they r e fl ec t and conv ey a varie ty of epis temic view point s. 496 3. 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 prioriti 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 and knowl edge in dec i s i on -making . 499 4. 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 kno 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 liv ed exp erience , loca l, cult ural, poli ti ca l and traditi onal knowl edge of ind i vidua ls a nd 502 co mmunitie s. 503 Part ner s h i p wo r k ing 504 1. 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 framew o r k s a n d proce s se s in glob a l hea l t h coll abor ation s . 506 2. 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 partn 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 inv olved. 509 3. 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 a 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 Structure o f glo bal h ealt h 512 1. 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 glo 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 cu 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 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 23 cu 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 for 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 how progre ss s hould be me as ured . 518 2. 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 LMIC -l ed co llab ora tion s. 520 3. 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 hea lth l eade rship po siti on s. 522 4. 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 indi 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 addre s sed and a ction s a re e valu a ted . 525 Indi vidu al du ty 526 1. 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 ac 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 2. 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 for 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 The 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 the 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 more 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 discu 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 revea ling a cl ea rer pa th forward for thi s critic ally importa nt move men t. 535 L i m i ta ti o n s 536 The 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 discu 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 bia 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 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 24 t 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 strat 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 that 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 buzz 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 funde 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 wi 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 this review . 546 Indee 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 loc 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 donor -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 and 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 recom 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 this termin ology doe s not n eed to be dec olonis ing global heal th. 552 The 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 dec 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 as 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 k 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 i 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 tangi 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 wi t hi n globa l hea l t h may b e mitiga te d. 559 It 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 Tw 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 re 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 led 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 rangi 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 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 25 tho 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 interve 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 per 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 hea 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 move ment i s need e d. 569 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 26 Ack nowledge ment s 570 The 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 at 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 dev eloping th e s earch st r a te gy for t his re vie w. 573 Fundi ng 574 The 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 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 27

s 576 1. 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 Global Public Heal th, 20 22. 2 (11 ): p . e00 003 06. 578 2. 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 revi ews. B MJ, 2021 . 372: p. n71. 580 3. 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 Inte 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 4. 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 betw ee n a syste ma tic or scop in g r e vie w app r o ac h. BM C Medic al Re se arch M ethod ology , 584 2018 . 18 (1): p . 143. 585 5 . B ü y üm , A .M . , et a l. , Dec ol oni sin g g l ob al he alt h: if n ot now, when ? B MJ Glo ba l He alth , 2020 . 586 5 (8): p . e00339 4. 587 6. Khan , M ., et al., D ecol oni sin g glob al he al t h in 2021 : a ro adm ap t o m ove fro m r h et or i c to 588 reform . BM J glo bal hea l th, 2021 . 6 (3) . 589 7. La wrenc e, D .S. and L . A. Hir s c h, De col onisi ng gl ob al he al th : tra nsn a t i o n al rese arch 590 part ner s h ip s u nder the sp otli gh t. In ter n a t i onal he alth , 202 0. 12 (6) : p. 518 -523. 591 8. Ot i , S . an d J. N c ayi yana, Dec oloni si ng g lobal he a lt h: w here ar e t he Sou the r n vo ices? B M J 592 glo bal hea lt h, 2021 . 6 (7 ): p. e 006576- NA. 593 9. Hommes, F ., e t al ., Th e w ord s w e cho ose m atte r : rec og nisi ng the i m por t an ce o f la ng ua ge i n 594 dec oloni s in g glo bal heal th. T h e La ncet Gl oba l Heal th, 2 021. 9 (7 ): p . e897- e8 98. 595 10. Moga ka, O.e .F ., J. S te war t, a nd E . B uk us i , W hy and for wh om are we d ec oloni sin g glo ba l 596 hea lth ? The Lan ce t Gl obal H e al th, 2021 . 9 (10): p . e1359- e13 60. 597 11. Hort on , R ., O ffli ne : The myth o f " d ecol oni sing gl obal h e alt h". La nce t (L on don , Engla nd) , 598 2021 . 398(103 12): p . 16 73. 599 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 28 12. Opara , I. N. It’ s Time to Dec olo ni z e the De colo niz a t io n Move m en t . 2021 2021 [ci t e d 2022 2 4]; 600 Ava ilable fr om: h t tp s: // speaki ngo fmedic i ne.pl o s.org/2021 /07/29 /i ts- time -to -dec o lonize -th e-601 dec oloniza tion -move men t . 602 13. Khan , T . D e colo ni s a t i o n i s a c om fortab l e buzz w or d for t he ai d s ector . 202 1; A v ai la ble fr o m: 603 http s : / /www .opendemo c racy .ne t/e n/de c olonis ation -c om fortab le -buzzword -ai d -sec t or / . 604 14. Sc hönebe rg, J . Devel op men t : a fail e d proje ct. 201 9; Ava ila ble fr o m: 605 http s : / /www .opendemo c racy .ne t/e n/ou rec onomy/d eve lopmen t- fail e d -pr oj ec t/ . 606 15. Ouz zani, M. , e t al . , R ayy an—a we b a nd m obile ap p for syst ema tic r e vie w s . Syst ematic 607 R e vi e w s , 2 0 16. 5 (1) : p. 210. 608 16. Wong, G ., e t al. , RA MESE S p ublic ati on s t and ard s: m e ta -n arr ati ve r e v i ew s. B M C M ed i c i n e, 609 2013 . 11 (1): p . 20. 610 17. Mei ste rLab s, Min dme i ster . 2 023. 611 18. Adams , G. a nd S . Estrad a - Villal ta, The o r y from the Sou th : a dec olo nia l ap pr oac h to the 612 psyc holo gy of glo ba l in eq u ality. C u r r ent opin ion in p syc holog y, 201 7. 18 : p. 37-42 . 613 19. Chan g, A .Y., M. L aker - Oket ta, a nd S .J . Coat e s , Priori tiz i n g eq u ity and inc lu si on in glo bal 614 hea lth der mat olo gy . Int erna tional jour na l of women's de rma t o lo gy, 2 021. 7 (2) : p . 154-157 . 615 20. Chaw la, B., J. L ind er t , a nd D. S ha rma, P os t -deco lo ni sati on : Gl obal Heal th and Glo ba l 616 Surge r y 's Coming of A ge. The Indian jour nal of surge ry, 2022. 84 (2) : p. 259 - 2 61. 617 21. Foreti a , D .A. , To dec olonize gl oba l s urgery and glo ba l h e alt h we must be radic ally 618 inten tio nal . Am J S ur g , 2023 . 225 (3): p . 5 95-596. 619 22. Bua, E . and S .L . S ahi, Dec olo ni z in g t he d ecol o niza t i o n m ove m en t in glo ba l h eal th : A 620 pers pec t i ve from gl ob al s urgery. F r o n t i e rs in Educa t i o n, 2022. 7 . 621 23. Daung supaw ong, H. and V. Wiw anitk it, L ett e r t o the Edi tor: Levera gin g Chat GPT t o 622 dem ocra tiz e an d d ec oloniz e g l ob al s ur gery: Large la ngu a ge m o del s for small heal thc are 623 b u dge ts . World J S ur g , 2024 . 48 (1 ): p . 2 52-253. 624 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 29 24. Dako, F ., T.S . O mofoy e, and J. Sc hee l, R a diol ogi st s ' Role in Dec olo nizin g Gl ob a l H e alt h. J A m 625 Coll Radiol , 2024. 21 (8 ): p. 117 2 -1179. 626 25. Krugma n, D.W., et al ., Cance r l ing uis tics an d the p olitic s o f deco lo niz ing he al t h 627 co mmunic a tion in Co as t a l Ta nza nia: Re f lec tion s fro m an an thr opol og ical inve s t i gati on . S o c 628 Sc i Med, 2024. 35 4: p. 11 7082. 629 26. Erondu, N . A., D . P eprah , and M.S . Kh an, Can sch o ol s of gl ob a l publ ic h eal t h di sman tle 630 co lonial leg ac ies ? Na ture me dic ine, 2020 . 26 (10) : p. 15 04-1505 . 631 27. Aff un -Adegbul u, C. an d O . Adegbulu , Decol oni si ng glo bal (p ubl ic) he al th : fro m We st ern 632 univer s a li sm t o gl ob al pluri v e r s aliti es . B MJ Glob al H e al th, 202 0. 5 (8): p . e002947 . 633 28. Kaha mbing, J. G . , D eco lonizi ng p u blic a nd pl ane tary he alt h, or C ht hul uc ene m edi ati on s . J 634 Publi c Heal t h (Oxf), 2023 . 45 ( 3 ): p. e607 -e 608. 635 29. Adebi si, Y. A., D e colo n iz in g Epide m iol ogic al Re searc h: A C r itic al Pe rs pec t i ve. Av ice nna J Me d, 636 2023 . 13 (2): p . 68-76 . 637 30. Est ebane z, J. and P . Boi rea u, On e He al t h: A s o ci a l s c i en c e d is cuss i o n of a gl o bal ag e n da. U n e 638 seul e sant e : di s c u ssion en scienc e s s oc ia le s d' un progr amme m ondial ., 2022. 29 : p. 17 . 639 31. Riv er a - Sega rra, E . , e t al ., Gl ob a l me nt al he alt h re s e arch an d pra ctice : a dec oloni al ap pro ach . 640 The lanc et . P sychi at r y , 2022. 9 (7) : p. 59 5 -600. 641 32. Ell iott , M. , Ar t s -b a s e d me th od s a s a critic al and deco loni si ng proc e ss in glo bal me ntal h e al th : 642 Refle ctio n s on po pul ar di s c our s e , arti s t ic rigour a n d lim i t a t i on s. Me thod s in Psyc hol ogy , 643 2024 . 10 . 644 33. Dec oloniz ing gl o bal he a lth by e n gin ee r in g equi ta bl e rel ati on shi ps . Natu r e Revi ew s 645 Bioen gine ering , 2024. 2 (6): p . 44 3-443. 646 3 4 . H a y n e s , E . , e t a l . , Decol onizi ng i nd i ge nou s hea l th : g ene rati ng a prod uc t i ve d ialo gue t o 647 e l im i n at e r h euma t i c h ea rt dis eas e in A ust r a li a. Soc ial Sci ence & Me di cine, 2021. 27 7 . 648 35. Kidde ll-M onro e, R ., e t al. , C om mu nityF irs t sol uti on s for C O VI D-19: dec olo ni sing h e alth crise s 649 resp on se s . The L anc e t . Plan eta ry health , 2 021. 5 (8): p . e499 -e 500. 650 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 30 36. Harr i s , M ., D e col o niz i n g Heal thc ar e Inn o vat i on . 202 4. 651 37. Da ff e, Z.N ., Y. G ui ll aume, a nd L .C . Iver s, A n t i- Ra ci s m an d A n t i- C o lo nia l i sm P r ax i s in Gl o bal 652 Healt h-R efle cti on a n d Actio n f o r P r ac ti tio ners in US Ac ademic Me dic al Ce n t e rs. Th e Americ a n 653 journal of tr opi cal me dic ine and hygi ene , 202 1. 105(3): p . 557-560 . 654 38. Much atu t a , M. , et al., B uil din g a fra me wo r k t o d ecol onize glo bal e mer genc y med icine . A E M 655 Educ Train, 2024. 8 (3) : p. e10 982. 656 39. Doz o i s , A., et al ., A t oo lki t f or dec olo ni z in g glo bal em erge nc y me dici ne ed uca tion . F r o n t ie rs in 657 Educ ation, 2 023. 8 . 658 40. Hirs c h, L. A., I s it p o s si ble to de colon i s e g lob al hea l th in stit utio n s. La ncet (Londo n , Englan d), 659 2021 . 397(102 70): p . 18 9-190. 660 41. Eic hbaum, Q. G. , et a l. , D e colo niz i n g G lo b al H e al th Educ ati on : Rethi nki ng I nstit utio na l 661 Part ner s h i ps and Appr oac he s. Ac adem ic medic ine : journal o f t h e A ssoc iatio n o f America n 662 Medic al C ol lege s, 20 21. 96 (3): p . 329-33 5. 663 42. Jolly , R. J . , Dec olo ni sing 'm an', re s i tua t i n g pa nde mi c: an i nter ve n t i on i n th e p at h ogen e s i s of 664 co lonial capi tal i s m . Medica l human i t i e s, 2022. 48 (2): p . 221 - 2 29 . 665 43. Olusa nya, J. O ., e t al ., T r ans f or m ing g lo ba l h eal t h th r o ug h equ i t y -d r i ven fu ndi ng . N a t u r e 666 Medic ine, 2 021. 27 ( 7 ): p. 1136 - 1 138 . 667 44. Yerramil li, P. To Deco l onize G l o bal Heal t h, We Mu st Exa mine t he Gl ob al Pol i t i ca l Ec onomy . 668 2021 20 21 [ c it ed 2022 24]; Avail able fr o m: 669 http s : / / w ww .t h inkgl obalhe a lth .or g / a rtic le/d ecol oniz e - g lob al-h e al th-we -mu st -e xami ne-670 glo bal-poli tic al -ec on omy . 671 45. Qa to, D . M., Re flectio n s o n 'De colon iz i n g' Big Dat a in Gl obal He alt h. Ann a ls o f gl o bal hea lt h , 672 2022 . 88 (1): p . 56. 673 46. Matagi , S .O. , Ef fort s to a Bel ie f and Dec oloniz e Glo bal H e alt h. J ournal of Adv anc e s i n 674 Medic ine a nd M edic al R es earc h , 2023. 35 (12): p . 16-21. 675 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 31 47. Bart el s, S. M., et al., Divers i fy ing Impl eme nta tio n Scie nce : A Gl ob al P e r s pec tiv e . G lo ba l h eal t h, 676 scien ce a nd prac tic e, 202 2. 10 (4 ): p . e21 0075 7-e21007 57. 677 4 8 . R e n m ans , D . , et a l ., Rea li st eva lua ti on in t im e s of deco lo nisi ng glo bal hea lth . T h e 678 Inte rna tiona l journ al o f h ealth pl a nning a nd mana gemen t, 2022. 679 49. De Camp, M. , et al., Dec oloni zing Glo bal Heal th Re se arc h: P er spe ctive s fro m US an d 680 Inter na tion a l Gl ob al Hea lth Traine e s. An n G lob H e al th, 202 3. 89 (1): p . 9. 681 50. Araujo, L.F ., et a l., C halle ng e s for brea k ing d own the ol d co lo nial order i n gl oba l he al t h 682 research : t he r ole o f res earc h f undi ng . The L anc et. G l obal h e alt h, 202 1. 9 (8 ): p. e 1 057. 683 5 1 . A d h i ka r i , S . , et al. , The w ay forwa rd i n d ec oloni sing gl o bal h ea lth . Lanc et Gl ob He alth , 2023 . 684 11 (7): p . e982. 685 52. Khan , S.A ., Dec olo ni s i ng glob al h eal th b y dec oloni s in g aca d emic pu bli shi ng . B M J g l o b a l 686 hea lth , 2022. 7 (3 ): p. e0 07811 -e00 7811 . 687 53. Abimbol a, S ., T h e fo r e ig n g az e : au thor s hip in a cade m ic glob al h ea l th. BMJ glo bal hea l t h , 688 2019 . 4 (5): p . e 002068 -NA . 689 54. Abraham, S., et al ., Wh a t I s G lob al He alth : Sc ienc e a nd Prac tice D oing to Ad dres s Pow er 690 Imb al ance s in P ubli sh ing ? Glob al heal th, scie nce a nd prac t i ce, 2 020. 8 (3): p . 325-3 26. 691 55. Abimbol a, S . a nd M . Pai , U n do in g su premac y in gl o bal h e alt h wil l r e quir e more t ha n 692 dec oloni s a tio n - Au th ors' repl y. L ance t ( L ondon, E nglan d ) , 2021. 397(10279 ) : p. 1 058 - 1 059. 693 56. Bina gwah o, A ., B . Nga rambe , a nd K. Ma thewo s, E l i m inat in g t h e W h it e Sup r e macy M i n d s e t 694 from Glob al H e al th Ed uc atio n. A nna l s o f G lo bal He alth , 2022. 88 (1) : p. 32. 695 57. Sa yegh, H., e t al., Glo bal h e alt h ed uc ati on in hi gh -in com e c ountri es : c onfr onti n g col oniali ty 696 and p ower a symm etr y . BM J globa l he al th, 2022. 7 (5) : p. e0 08501 -e00 8501. 697 58. Lo kugam age, A. U ., e t al., Tran sform ati ona l lea rni n g t o dec olon i s e gl ob al h ea lth. L a n c e t 698 (Lon don, Eng land ), 20 21. 397 ( 1 0278 ): p. 9 68-969. 699 59. Adams , L . V. , e t al., Th e fu tu r e o f g lo ba l he a lt h ed u c at i o n : t r a in in g fo r eq ui t y in g lob a l h eal t h. 700 BMC med ical educa t i on, 2016 . 16 (1 ): p. 2 96. 701 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 32 60. Demir, I. , H ow a n d Why Shoul d We D ec olonize Glo b al Heal th Ed uc at i on a nd Rese arch? 702 Annal s of g lob al h eal th, 20 22. 88 (1 ): p . 30. 703 61. Bhak uni, H. and S . Abimb ol a, E p i s t e mic i n j u s t ic e in a ca de m ic gl ob a l h e a lt h. T h e L a n c e t . 704 Global h ealth , 2 021. 9 ( 1 0) : p . e 1 4 65- e 1 47 0 . 705 62. Eltay b, A. , et al., G lo b al He alt h a nd D ec oloni sati on i n Hig her Ed uca tion : Exa m inin g t he 706 Atti t u de s , Percep tio n s an d Po ssibil i t i e s of E ducator s . Philo sophy a nd Theory in Hig her 707 Educ ation, 2 023. 5 (3): p . 537-563 . 708 6 3 . K a lb a r c z y k , A ., e t a l. , D ec o lo ni z ing g lo b al h e a l th c u r r i c u l um : f r om fa d to f ou ndat ion . Fron tie r s 709 in E ducatio n, 2023. 8 . 710 6 4 . B l e a k l e y , A . , J . B r i c e , a n d J . B l i g h , Think i ng th e po s t -c oloni al in me dical e duca t i o n . M e d i c a l 711 educ atio n, 2 008. 42 (3 ): p . 2 6 6 - 7 0 . 712 65. Rodney , R., Dec olon iza tion i n heal th p r o f e ssio ns e duc ati on: re flec tio n s on te ac hin g thro ug h a 713 t r a ns gr e ss i ve p e da go gy . Ca n adian medic a l educ ati on jou r na l, 2016 . 7 (3) : p. e 10 -e 18. 714 66. Kule s a , J. and N. A. Bra ntuo , B ar rie rs t o de col o ni s i n g e du cati on al part ner s hi p s i n glob a l 715 hea lth . B MJ globa l h eal t h , 2021. 6 (11 ). 716 67. Fuj imara, R. and Y . J a bbarp our, K no wl edg e i s P ower: A s s e ssi ng Acade mic D e colo niz a tio n 717 thro ugh Bi direc t i o nality of Trai nin g in G l ob al H e al th F ellow s hi ps. McGill Jo urn al of Glob al 718 Health , 2 023. 12 ( 1 ): p. 16 -26. 719 6 8 . R e es , C .A . , e t a l ., H a s Aut hor s hi p in t h e Decol o nizin g Gl ob al Heal th Move ment Bee n 720 Colo niz e d? An n Glob Hea lth , 2023. 89 (1) : p. 4 2. 721 69. Bump, J .B. and I. Ani e bo, C olo ni ali sm, m alaria, a nd the de col on izatio n o f glo bal h ealth . P L O S 722 Global Public Heal th, 20 22. 2 (9 ): p . e000 093 6-e00009 36. 723 70. Fofa n a, M. O., D ecol oni sin g glo b al he a lt h in the tim e of C OVI D-19. G l obal publ ic he alth, 2020 . 724 16 (8): p . 1155-11 66. 725 71. Kwe t e , X., et a l ., Dec ol onizi ng gl o bal he a l th: wha t s houl d be t he tar get o f thi s mo vemen t an d 726 wh ere doe s it le ad u s? Globa l h eal th r e se arc h and p olicy , 2022. 7 (1 ): p. 3 . 727 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 33 72. Wardle , J ., Decol o ni sing in tegr ative he al th: learn ing more fr om an d ele v ati ng th e voi ces o f 728 rich but of ten neg lect ed h ealt h tr adi tion s . Adva nce s in Int eg r a t i ve Medic in e, 2 022 . 9 (1) : p. 1 -729 2. 730 73. La uren s , V. and C. A ba día -Ba rre ro, De c o lo n i z i ng g l oba l h eal t h , in The Rou tled ge Ha nd book o f 731 Ant hrop olo gy and Gl ob a l Healt h . 2 024. p . 293-307. 732 74. Abimbol a, S . and M. P ai, Will gl obal healt h surviv e it s dec olo ni sa tion . L a n c e t ( L o n don , 733 Eng land), 20 20. 396 (10263 ): p. 1627 -162 8 . 734 75. Barnab e , C., T oward s a tt ainm e n t o f in di gen ou s he al th thro ug h e m powe r m e n t: re se tt in g 735 hea lth s y s te ms , ser vic es a nd pr ov ider ap proac he s. B MJ G lobal H e a lth , 2021. 6 (2) . 736 76. Olusa nya, B .O. , M. Ma llew a , a nd F .A. O g bo, Be yon d ple dg e s : aca de mic journ al s i n hi gh -737 inc ome c ountri es can d o mo r e t o de colo n is e gl ob al he al th . BMJ g lobal h e alth , 2021. 6 (5): p . 738 e00 6200-N A . 739 77. Keshri , V.R . a nd S . Bh aumik, Th e f e u d a l s t r u c t u re of gl ob a l h ea lt h an d i ts imp l ic at i ons f or 740 dec oloni s a tio n. BM J global he alth, 2022 . 7 (9): p . e0106 03- N A . 741 78. Gauti er, L., e t al ., Re thi nki ng de ve lo pme nt int erv en tio ns thro ug h the len s o f d ecol oni ality i n 742 su b-Sa har an Afric a: The ca se o f g lo bal h e alth . Glob P ublic H e al th, 2022 . 17 (2) : p. 1 80-193. 743 79. Hirs c h, L .A ., In t he w a ke : In t e r pr et ing c a r e and g lob a l h ea l th t hr oug h B l ac k ge o gr aph i es. 744 Area , 20 20. 52 (2) : p. 314 -321 . 745 80. Manne ll, J. , e t a l. , Dec ol oni s in g vi ole nc e a gai n st wo me n re se arch : a study de sig n f or c o-746 develo pi n g viole n ce prev e nt i o n i n t e r ve n tion s w ith com mu ni t i e s in l ow and mid dl e i ncome 747 co untr i e s ( L M ICS). BM C P ublic H e al th, 20 21 . 21 (1147 ). 748 81. Tuhe bwe, D., e t a l ., Applyi n g a P ow er An alysi s t o Everythin g W e Do : A Qual i t a ti ve I nqu ir y t o 749 Dec oloniz e t he Glob al Heal th a nd D e ve lop me nt Pr oje ct Cy cle . Globa l Heal t h : Sc ienc e a nd 750 Prac t i c e, 2 023. 11 ( 5 ) : p . e230 0187. 751 82. Reima gined , D ., F or m i ng a co a litio n of t he wil lin g to dec olo nis e gl ob al h eal th. I s it po ssible , 752 wh at im pac t could i t have , a nd w ha t nex t ? 2021 . 753 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 34 83. Pai , M. D e c o l o n i z i n g G l o b a l H e a l t h : A M o m e n t T o R e f l e c t O n A M o ve m e n t . 2021 2021 [ci t e d 754 2022 23]; Avai lable from : 755 http s : / /www .for b e s .c om / si te s / ma dhuka rpai / 20 21 / 07 / 22 /dec ol onizing-g l obal -he a lth - a -756 momen t-to -r efl ect -on -a -mov emen t/? sh = 593b158 45386 . 757 84. Spa nau s, E.S . D.S ., L. E, Deco lon isi ng Glob al H e alt h: Clari fyi ng Co nc ept s fo r E qui ta b le P r ac tice . 758 Epid emiol P ublic H e a lth, 2024 . 2 (3) : p. 1 0 47. 759 85. Airhihen bu wa, C.O ., e t al. , Dec olo niza ti on a nd an tiraci sm: i nter secti ng pat hw a ys to glo ba l 760 h e al t h e qu i t y. Ethn H ealth , 2 024. 29 (7 ): p . 846-86 0. 761 86. Khan , M. S., e t a l. , Co mm ittin g to an ti-r acism r ef orm s? Thr ee critica l buil d ing blo ck s for glo bal 762 hea lth org aniz ati on s. PLOS Gl oba l Pub li c Heal t h , 2022. 2 ( 7 ): p. e000 0653 -N A. 763 8 7 . T h e L a n ce t G l ob a l , H ., D e colo ni s i ng C O VI D -19 . The L anc et . Glob al h eal th, 20 20. 8 ( 5): p. e612 . 764 88. Na ssiri -An sari , T. and E.L .M . Rhule , Mi s s i n g in ac t i on : a s c opin g revi ew of ge n der a s the 765 overlooke d com p one nt in d eco loni al di s c ourse s. BMJ Glob Hea lth , 2024 . 9 (4 ). 766 89. Kunnuj i, M., et a l., Why 'ele vatin g c ou nt r y v oic e' is no t deco l onizi ng glob a l h eal t h: A frame 767 anal ysi s o f in -d ept h in t e r view s. PL O S Glo b Publi c Heal t h, 2023. 3 (2 ): p . e00 01365. 768 90. Iwe lunmor, J., T he tr uth ab out dec olo nis ing gl obal hea l t h wor t h spre adi ng . L a nc e t ( L o n don, 769 Eng land), 20 22. 399 (10338 ): p. 1863 -186 4 . 770 91. Krugma n, D. W ., Glo b al heal th a n d t he el i t e capt ure o f de colo nizati o n: On re formi sm and t h e 771 po ss i biliti es o f al t e r n a t e pa th s . PLOS Glo b P ublic H e al th, 202 3. 3 (6 ): p . e 0002103 . 772 92. Cont racto r, S . Q. a nd J . D asgup ta, Is de col oni s ati on s u f fic ient? B M J G l o b H e alt h , 2 02 2 . 7 (12) . 773 93. Eng ebret sen, E. a nd M . Bak e r, T he Rhe t oric of Decol o nizin g G l o bal He alt h Fail s to Ad d r e ss 774 t h e R ea li t y o f S e tt l e r C o l on ia l is m: G a z a a s a Cas e i n Poi n t. In t J Heal th P ol icy Man ag, 2024 . 775 13 : p . 8419. 776 94. Hellow ell, M. a n d P . N ayn a S chw erd t l e, P ower ful i dea s? Deco lo ni sat ion an d t h e fu ture o f 777 glob al hea l t h . BM J global heal th, 2022. 7 (1 ) . 778 95. TDR, et a l., Acti o n s f or de colo niz i n g glo b a l heal th . 2022. 779 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 35 96. Lo kugam age, A.U. , T. A h illan, an d S.D .C . Pa th beriya, Dec oloni s i ng ide a s of h eal in g in me dica l 780 e d uc a t io n. J ou rna l o f medic al eth ics , 2020 . 46 (4) : p. 2 65-272 . 781 97. Fi nkel, M .L., et a l. , W h a t D o G l ob a l H ea l t h P ra c t i t i on er s Th in k ab ou t D ec o l o n iz i ng G l ob a l 782 Healt h? Ann als o f glob al h ea lth , 2022. 88 (1): p . 6 1. 783 98. Olusa nya, B. O ., Ac coun ta b ility fram ew or k to dec oloni se gl o bal h ea l t h . Lanc et (Londo n , 784 Eng land), 20 21. 397 (10278 ): p. 968 . 785 99. Some r v ille, C . and K.R. Mu ng uambe, Th e r i s e of n on - co mm un i ca b l e dis eas e ( N C Ds ) i n 786 Mozam biq ue : d ecol oni si ng ge nde r and gl ob al he alth . G ende r & Dev elopme nt, 2021 . 29 (1) : 787 p. 1 89-206. 788 100. Alouda t , T. D o we nee d to de col on i s e g lo bal he alth ? 20 21 2021 [ci ted 202 2 24 ] ; Ava ilabl e 789 from: ht t ps : // de c o lo nis e .he a lt h / do - w e- ne e d- t o- de co l o n is e- g l o ba l- he a l t h- 2 3 a3 c a fd 43 5 e . 790 101. Adiab u, S ., Decol onizi ng gl obal h eal th fro m t h e per s pe ctive s of glob a l he alth ac tors in Low -791 midd le Inc ome C o un tr i e s . 2021. 792 102. Ca sto r , D. a nd L.N . Bor r el l, The c og niti ve dis s o na nce di s c our s e o f e v ol ving termi n ology fr o m 793 co lonial me dic ine t o glo ba l hea l t h and inactio n towar ds equ i ty - A Pr e ve ntiv e Med icin e 794 Gold en Ju bilee Ar tic le. P rev en tive medic i ne, 202 2. 163: p. 1072 27. 795 103. Chuk wuma, J .N., Decol o nisi ng gl o bal h ealth , i n T he Co mpa nio n t o D e vel o pm ent S tu die s . 796 2024 . p. 526 -531. 797 104. McCo y, D ., e t a l. , De vel opi ng an a ge n da for t he d ecol o niza t i o n o f glo bal he al th. Bull Worl d 798 Health Organ, 2024. 10 2 (2): p . 130 -136 . 799 105. Kuma r , R., R . Kh o s la , and D . McC oy, Dec oloni s in g g l obal he al th r e s e a r c h: Shi ftin g p ower for 800 tran sform ative ch an ge. P LOS Glob Pub lic Hea lth, 2024 . 4 (4) : p. e0 003141. 801 106. Ngaruiy a, C., M. I. M uhamma d, and N .A . Sam-Ag udu , A p r opo s ed g u i de to r e duc i n g bias and 802 improvi ng a sse s s m e nt s o f deco lo niza tio n in glo bal hea l t h re se arch . Fr o nt i e r s i n Ed u c at i on, 803 2024 . 9 . 804 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 36 107. Ratne r, L . , e t al ., Lea r n e r M i l es t on es t o G u i de D ec o l on ia l G l o ba l H ea lt h Edu c a t i on. Ann G l ob 805 Health , 2 022. 88 ( 1 ): p. 99. 806 108. Hindmarc h, S. an d S . Hillie r , R e im agini n g gl ob al heal th : From d ecol o nisa t i o n t o 807 indi ge niza tio n. Globa l public he a lth , 2022: p. 1-12 . 808 109. Avil a, P ., D ec o l o ni z ing G l ob a l H ea lt h: In c r e as in g C ap a ci t y of C omm u n it y H e alt h W or ke r 809 Progr am s. An n Glob H eal t h , 2023. 89 (1 ): p. 90. 810 110. Si lberne r, J . 4 Way s t o D e colo ni ze Gl ob al H e alth . 2022 202 2; A v ail a ble fr o m : 811 http s : / /magazine .jh s p h.e du/ 20 22 / 4 - w ay s -dec olo nize -globa l -he alth . 812 111. Le ncuc ha, R. , Tran s formi ng glo b al heal t h: d e colon i ality an d the h um an co n di tio n. B M J G l o b 813 Health , 2 024. 9 (8) . 814 112. Rama ni, S ., E .B. Whyle , a n d N. Kag wanja , W h a t re search evide nc e can su ppor t the 815 dec oloni s a tio n of gl ob al h eal th ? Mak i ng s pace for d eepe r sc holar shi p in gl o bal he a lt h 816 journal s . L anc et G l ob Heal th, 20 23. 11 (9 ) : p . e1464 -e 1468. 817 113. . 818 114. Whiteh ea d, C. , et a l., Th e In tern atio nal P ar tne r as In vi ted Gu es t: Bey o nd Col o nial an d Imp ort -819 Ex port Mo del s o f Me dica l Edu ca tion . A cade mic medic ine : journal of the A s soc iation o f 820 Americ an M edic al Col l ege s, 201 8. 93 (12) : p. 1760-17 63. 821 115. Poli dan o, K., et al. , Comm uni ty Engag e ment in Cu ta neo us L ei shm ani asi s Re s ea r c h in Braz il , 822 Ethio p ia, a nd S r i L anka : A Dec oloni a l Ap pr o ach for Gl ob al He al th. Fr ont ier s i n p ub l ic h e alt h, 823 2022 . 10 : p. 823844 . 824 116. de Ca mpo s-Rudi n s k y, T.C ., e t al ., D e colon i s in g glo bal h e alt h: why the new Pan demic 825 Agreem e nt sh o uld h ave incl ude d the p rinc iple o f sub s i diarity. Lanc et Glob H e al t h , 2024 . 826 12 (7): p . e1200 -e 1203. 827 117. Abimbol a, S., e t al ., A dd r es s i n g p o we r as ym m e t r i es i n g lo bal he a l th : Imp e r at i ves in th e w a k e 828 of t he C O V ID -19 p a nd emic . PL oS medi cin e, 2021. 18 (4 ): p. e1 003604 -N A. 829 118. Maio, F. D. a nd J . Kon fino, Glo ba l he al th: Reima gi nin g pe rsp ec t i ve s . 2020 . p . 3-13. 830 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 37 119. Herr i ck, C. , O. Okpak o, and J. D. A. Millin g t on , Une q ual ec osy s tem s o f g lob al heal th au tho r i a l 831 ex pertise : D ecol oni sin g no nc omm uni cabl e dise a se. He alth & pla ce , 2021. 71 : p . 1 02 67 0 . 832 120. Li wana g, H.J. a nd E . Rhule , D i alo g i ca l r ef le xi vi t y t o wa r ds co l l ec t i ve a c t i on t o t r an sfo r m g l ob al 833 hea lth . B MJ globa l h eal t h , 2021. 6 (8 ): p. e006 825-N A . 834 121. Kim, H., T he i mpl icit i de olo gic al func ti on of the glo b al h eal t h fi eld an d i ts r ole in main tai nin g 835 r e l a t i ons o f po w e r . B MJ Gl obal H e alth, 2 021 . 6 (4) . 836 122. Fa r a g, N., Why it’ s im port an t for fu ture heal thc ar e p r of e ss ional s to 837 unde rs tan d’ de colon iz i n g ’glo bal h ealt h, a nd how t hi s can b e d one . 2020. 838 123. Gedel a , K. , Un doi ng sup r e m acy in glo bal hea lth will re quire mo r e t h an dec olo nis at ion. L an cet 839 (Lon don, Eng land ), 20 21. 397 ( 1 0279 ): p. 1 058. 840 124. . 841 125. Cord eiro -Rod rigue s, L. , Tow ar d a dec ol onize d he alt hc are e th ics: C o loni al leg a cies a nd t h e 842 Si ames e croc odile . D evel oping w orld bio ethic s , 2020. 20 (3 ): p . 118 - 1 19. 843 126. Sha r ma , D . and N.A . S am- Agudu, De colo ni s i ng gl ob al heal th i n the Glo bal Sou th b y the Glob a l 844 Sou t h : turni n g the l e n s inward . BM J Glob Hea lth, 2023 . 8 (9) . 845 127. Ssen ny onnjo, A .W. , Phi llip ; Omolu a bi, Eli zabe t h ; W a i s w a , Pe te r, T he ‘ de colo n iz a ti on o f gl oba l 846 h e al t h’ ag e nda in A f r i c a: h a rn e ss in g s yn er g i e s w it h t h e c on t i n e nt ’s s t r at e g i c as p i r at io ns . Eu r J 847 Publi c Heal t h, 2023. 1 (33 (3) ): p . 358 - 3 59. 848 128. Union, A. , A g e nd a 20 63: The A fr ic a We Wan t. 849 129. Pra tt, B ., W ha t c on st i tut es fair sh a red de cisi on -m ak ing in glo bal h ealt h rese arc h 850 co llabora tio ns ? Bi oe thic s, 202 0. 34 (9 ): p . 984-993. 851 130. Chau dhu r i , M .M. , e t al., D e colo ni s i n g glo b al he alt h: b e yond 'ref orma tive' ro a dma ps an d 852 toward s dec ol oni al th oug ht . BMJ g lob al he alth , 202 1. 6 (7 ). 853 131. Nkeng a s on g, J. , B . D jou dalbay e , and O . M a iyeg un, A new p ubl ic heal th order for A fric a's 854 hea lth s e curity. T he L ance t Globa l H ealt h , 20 17. 5 (11): p . e106 4 -e1065. 855 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 38 132. Tee r a wa ttan anon , Y ., e t al ., W ha t Can We Le arn Fr om Othe rs t o De velo p a R eg ional Ce ntre 856 for In fectio u s Di se a s e s in ASE AN?; C o m ment o n "O pera tio nal i s in g Re gio nal Co o perati on f or 857 Inf ec tiou s D i se as e Contr ol: A Sc oping Re view of Regio na l D is ea se Con trol Bodi e s an d 858 Network s" . Int erna tional Journ al of H ealt h Pol icy and Mana gem ent, 2 022 . 11 . 859 133. Beg um, N . and R. S aini , Dec olo nis ing t he Curr ic ulum. Poli tica l Studi e s Rev iew, 2019. 17 (2 ) : p . 860 196-20 1. 861 134. Mitra , S ., S . S arka r, a n d A. G a nguli -Mi t ra, O n the n eed for an an ticol oni al per s p ecti ve i n 862 eng in eerin g educ a t i o n an d pr a ctice . N at ur e Communic a tion s, 2023. 14 (1) : p. 8 45 3. 863 135. Bowl eg, L., We’re Not All in T hi s Toge th er: On C OV ID -19, I nter s e ctio nali t y , an d S t ruc t u r a l 864 Ine q uali ty. A me r i can Journ a l of Publi c He alth, 2020. 11 0 (7 ): p . 917 -917. 865 866 867 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 39 S1 A ppe ndix: Dec olonis ing gl oba l health : A scoping r e view s earc h s trategy 868 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint 40 S2 A ppe ndix: Country of origi n for a ut h ors of incl uded papers 869 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2025. ; https://doi.org/10.1101/2025.03.26.25324588doi: medRxiv preprint