What next for decolonising health and medicine?

There is growing demand for decolonisation, described recently by Annabel Sowemimo, author of Divided: Racism, Medicine and Why We Need to Decolonise Healthcare, as a desire to examine how systems of race, class, and gender have been shaped by colonial history and how we move to establish a more equitable society.1 Across the UK and Europe, for example, newspapers, museums, charities, universities, and other organisations are reckoning with their pasts born of European colonialism that sought to invade, control, extract resources, and impose western views on much of the rest of the world. Today’s world is shaped by this colonialism—the wealth of high income countries was generated by land theft and slavery, establishing a legacy of power and exploitation that persists to this day. Decolonisation is thus not just about former colonies gaining political independence from former empires but encompasses efforts to rebuild institutions and knowledge systems without the cultural and social effects of colonial era violence, racism, misogyny, and Eurocentrism.

Decolonisation matters profoundly to health because empire shaped medicine: from experimentation on enslaved populations to the codification of “race” in social and physical histories, to the entrenchment of western scientific paradigms as the basis for medical practice.23 Colonial legacies have left their imprint on modern health systems through practices such as under-investment in housing, poverty reduction, and other health determinants; the erasure of Indigenous health practices; and the norm of white male bodies in anatomy and clinical trial design. The result is flawed healthcare practices for all, the marginalisation of racialised people and women, and persistent structural health inequities reflected in worse outcomes for these groups.1234The BMJ, which began publishing in 1840, and its owner, the British Medical Association, are undeniably products of colonialism, and like other British journals such as the Lancet, were used, at least in part, to advance imperial objectives.5

Recent decolonisation movements in global health have drawn needed attention to how histories of exclusion and inequity shape current systems of knowledge production and health, and in particular to the continued dominance of global north perspectives over the global south. Calls to #decoloniseglobalhealth ask that equity and justice be centred in practice internationally and that all forms of supremacy be overcome67: white supremacy, male domination, the privileging of high income country perspectives over local expertise and lived experience, and the superiority of western culture and research paradigms to the exclusion of Indigenous and other knowledge systems. In parallel to decolonisation advocacy, and spurred by the #BlackLivesMatter, #metoo, and other equity movements, many health and medical institutions have pledged to increase diversity, equity and inclusion. But pledges alone are not enough, and decolonisation movements themselves risk being co-opted by buzzwords, tokenism, and white saviourism.89 It is clear that far deeper, radical changes are needed to create just, equitable, and inclusive knowledge and health for all. Current inequities and lack of progress in health are linked to a failure to confront colonial pasts, and decolonising requires us to meaningfully restore power and agency to marginalised interests and groups, not merely to acknowledge, apologise, or rename old buildings.

So what next for decolonising health and medicine? Today we release a podcast series and article series in The BMJ1011121314 to examine progress towards decolonialism and discuss the current state of the movement. What’s missing in the current agenda? Whose voices and perspectives need elevating? What does decolonising health and knowledge mean in practical terms for medical professionals, educators, researchers, and journals? What institutional leadership and action are needed to drive change?

Our goal is to put the perspectives and voices of people marginalised by colonialism at the centre of this work. We seek to amplify multidisciplinary perspectives from established as well as new scholars, practitioners, and advocates of decolonisation worldwide, and we include contributions from leaders in colonial era institutions the London School of Hygiene and Tropical Medicine and the British Medical Association.

The podcast series highlights how colonial histories, including race science, live on in the ways we teach, define, and practise healthcare. Discussions emphasise that decolonisation will not be achieved without tackling gender inequities, racism, and other forms of structural violence as well as the coloniality that has created norms of dependency in low and middle income countries.15 Podcast guests draw links between feminist and decolonial approaches to health and the need to unite against global conservative movements impeding progress towards health justice and equity. They discuss their frustrations with decolonisation efforts slipping into slogans and signalling on social media, deflecting attention from deeper work to highlight inequitable and extractive institutional arrangements, including academic promotion, authorship norms, publishing practices, and global health partnerships.

Recurring themes include the need for health professionals to be better educated about colonial histories and the importance of change requiring no less than the dismantling of current structures—health institutions must cede power and invest authority in grassroots and community based experience and expertise. Guests emphasised that meaningful decolonising work must be uncomfortable: institutional leaders and practitioners should feel challenged. And change will be revolutionary, messy, and multigenerational—but also compassionate.

We continue to reflect on our own positionality and privilege as mostly white editors, born and trained in coloniser or settler countries, working at a colonial era journal based in a former empire. We expressly do not view ourselves as experts in decolonising health but as allies interested in learning, improving our practice, and using The BMJ to work collaboratively towards our mission of improving health and wellbeing outcomes for people and the planet, and to advance conversations on health justice and equity globally. We are grateful to our podcast guests for sharing their personal and professional stories, their expertise, and their valuable time. We welcome readers’ feedback, suggestions for new topics to explore, and submission of further articles for this series.