The C-Word: Tackling the enduring legacy of colonialism in global health

Global health is only the newest iteration of what was formerly “international health”, “tropical medicine” and “colonial medicine”

The C-Word: Tackling the enduring legacy of colonialism in global health

By Sudipta Saha, Purvaja Kavattur, Amina Goheer

As part of a student collective, we organized the Decolonizing Global Health Conference at Harvard T.H. Chan School of Public Health in February 2019. The collective emerged out of frustrations with how “global health” is taught in depoliticized, un-critical and ahistorical ways.

Proposed definitions of “global health” are generally depoliticized and include invocations of trans-national health issues and collaborations. Yet global health is only the newest iteration of what was formerly “international health”, “tropical medicine” and “colonial medicine”. Its historical roots lie in European colonial endeavors and imperial interests. Just as those reflected the unequal power relations of that time, global health reflects the unequal relations of present. North American and European universities, including Harvard, play a big role in this nebulous field. Syllabi, implicit theories, and agendas in these institutions posit the field as a technical one whose methods are universal, objective and value-neutral. They portray the field as being devoid of its historical baggage, and do not critically challenge the underlying economic (e.g., neoliberalism) and political relations (e.g., US imperialism) that constrain mainstream global health.

We organized the conference with a desire to bring together students and professionals interested in international health who are at odds with the institutional frameworks they find themselves in. Folks who may enter the area with a utopian and redistributive vision of health internationalism, but whose work maybe dependent on the largesse of a billionaire (e.g. Bill Gates) or who may be working at an institution like Harvard whose endowment equals Nicaragua or Mozambique’s GDP (and where the global health department’s tenured faculty are almost exclusively white men).

The conference was not meant to answer what “decolonization” means in all contexts, or to distill the concept into a series of steps and checkboxes for an institution to tick off so that they can slap on a “decolonized” badge. In fact, one of the sentiments expressed in the conference was that the term decolonization should be reserved for meaning the end of settler-colonialism in the North American context, and using the term for anything else employs decolonization as a metaphor. Others thought it was a useful marker under which those interested in challenging colonialism and its enduring power structures (coloniality) could organize.

We held workshops on critical pedagogy and decolonizing syllabi, where a widespread frustration emerged with how global health is taught in universities in the United States in ways that create and perpetuate neo-colonial relations; even mentioning the c-word was considered radical in some institutional settings. In other panels, we explored:

  • how and why ideas like the New International Economic Order provide alternative conceptualizations of the “global” that fundamentally tackle structures of power;
  • how imposed austerity to limit state functions, combined with philanthro-capitalism and earmarked aid, are manifestations of coloniality;
  • how market- and target-driven family planning policies have coerced vulnerable women and infringed on their sexual and reproductive health rights, and how these coercive population control policies are not a thing of the past; and
  • how decolonization should involve deconstructing history, reclaiming space, and developing radically – not incrementally – alternative visions.

Tension emerged between some of these ideas during discussions. For example, what is the point of making syllabi more critical in colonial institutions if those institutions are not fundamentally challenged? Will more “woke” folks help if they are still a member of a colonial institution? On the other hand, perhaps this is a part and parcel of decolonizing as a political project; a critical step in challenging epistemic violence that erases histories of “colonial subjects”, devalues their epistemologies, and posits particular Eurocentric theoretical frameworks as modern or “enlightened”. Suffice to say, out of the conference emerged questions that are not asked in current iterations of institutionalized global health. Yet, these said and unsaid questions are crucial for they force us to interrogate the foundations of hegemonic narratives and the institutions that they have created. In doing so, we are forced to reckon with the fact that dominant notions are but one of many possible constructions, and through this questioning and mindful learning we can envision reconstructing the current world order.

What does decolonizing mean when we think of global health as an academic and technocratic enterprise? Would it be a metaphorical use of the word where we co-opt a deeply revolutionary idea to signify minor changes, for example, supposedly better research “partnerships”? What does decolonizing look like when we think of global health as the health of peoples around the world, if that health (or lack thereof) is the result of people embodying the myriad social, political and economic situations in which they live? What does decolonizing look like as a political project to further people’s health, when we are going against deeply ingrained, often invisible neo-colonial power structures? Additionally, what does it mean to have a conference on decolonization at a university like Harvard? Is it possible to acknowledge the hypocrisy of that notion and yet still work towards something subversive and counter-hegemonic?

In short, the conference definitely was not an act of “decolonization.” Decolonization is not a one-day event or a checkbox. It is a process – a process that leads to futures we do not know, but that we should dare to imagine.

3 responses to “The C-Word: Tackling the enduring legacy of colonialism in global health”

  1. […] 11. Saha S, Kavattur P, Goheer A. The C-Phrase: Tackling the enduring legacy of colonialism in international well being. Well being Methods World; 2019 [cited 2021 Mar 13]. Accessible from: https://healthsystemsglobal.org/news/the-c-word-tackling-the-enduring-legacy-of-colonialism-in-globa…. […]

  2. […] 11. Saha S, Kavattur P, Goheer A. The C-Phrase: Tackling the enduring legacy of colonialism in international well being. Well being Techniques International; 2019 [cited 2021 Mar 13]. Accessible from: https://healthsystemsglobal.org/news/the-c-word-tackling-the-enduring-legacy-of-colonialism-in-globa…. […]

  3. […] 11. Saha S, Kavattur P, Goheer A. The C-Phrase: Tackling the enduring legacy of colonialism in international well being. Well being Techniques World; 2019 [cited 2021 Mar 13]. Accessible from: https://healthsystemsglobal.org/news/the-c-word-tackling-the-enduring-legacy-of-colonialism-in-globa…. […]

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