Decolonization Without Reform: A Critical Appraisal of Global Health Scholarship
By Luchuo Engelbert Bain , MD, PhD
The call to decolonize global health has gained global momentum, yet the movement risks sliding into buzzwords, elite capture, and conceptually thin rhetoric detached from lived realities. Despite broad agreement on equity and epistemic justice, current scholarship often reproduces epistemic violence, linguistic domination, and extractive power structures. This critique interrogates these limitations and asks: What does meaningful decolonization require beyond slogans? Are the root problems elsewhere? Have we identified the true elephant in the room, or are we still circling it?
A Movement Captured: Who Speaks for Decolonization?
One of the most glaring features of the current discourse is its elite capture. The conversation is largely shaped by scholars based in the Global North, many of whom are originally from the Global South but now occupy prestigious positions in Northern institutions. While their contributions are valid, this phenomenon raises troubling questions: Who sets the agenda? Who gets cited? Who receives funding to “decolonize”? The paradox is stark. Calls to decolonize global health are often led and funded by the very structures that require decolonizing. This risks entrenching the very power imbalances the movement seeks to dismantle.
Most cited authors on decolonizing global health are affiliated with elite institutions in the United States and United Kingdom. Despite their geographic origins, their institutional positions influence the framing, methodology, and reach of their work. The result is a version of decolonization that is palatable to mainstream academia but often detached from the lived realities of health systems, scholars, and communities in the Global South.
On the Need to Own the Issue and Speak Up
We cannot ignore the disturbingly few voices from the Global South, the most affected, involved in this discussion. While we agree that politics and Northern-dominated funding frameworks discourage the most affected from speaking up openly, the status quo will only change when a critical mass of informed people who live these issues become uncomfortable enough to speak up.
Siloed Scholarship and Disciplinary Gatekeeping
The decolonization of global health scholarship suffers from disciplinary insularity. Dominated by biomedical paradigms and public health metrics, the field often sidelines perspectives from political science, anthropology, the history of medicine, and international relations. Yet these disciplines are essential for understanding the colonial roots of global health and the contemporary manifestations of epistemic injustice.
Without a truly transdisciplinary and inclusive approach, decolonization becomes a hollow exercise. We need a shared understanding that decolonizing global health cannot be achieved within disciplinary silos. Historians of science can illuminate the colonial logics embedded in modern health systems. Political scientists can interrogate power and aid structures. Anthropologists can offer ethnographic insights into the lived experiences of health inequity. Without this breadth, we risk reproducing colonial knowledge systems under the guise of reform.
The Theoretical Void and Linguistic Hegemony
Another critical issue is the absence of robust theoretical grounding. Despite the proliferation of conferences and workshops on decolonizing global health, few provide clear conceptual frameworks or guidelines. What does it mean to decolonize global health? What constitutes a decolonial lens? Who has the authority to define it? These foundational questions remain largely unanswered.
Moreover, the dominance of English as the language of discourse further alienates non-Anglophone scholars and perpetuates linguistic colonialism. Knowledge produced in French-, Portuguese-, or Arabic-speaking African countries, for instance, remains underrepresented and undercited. True decolonization requires linguistic pluralism and epistemic inclusion, not just geographical diversity.
Tokenism and the Illusion of Inclusion
Performative decolonization often manifests in tokenistic practices: including one Global South author on a paper, inviting a Southern speaker for representation, or listing Southern institutions as collaborators without real power-sharing. These symbolic gestures mask deeper structural inequalities and can even be used to deflect criticism.
What is needed is not symbolic inclusion but structural transformation: shifting who sets research agendas, who controls funding, and who defines what counts as evidence or success. This requires moving beyond optics to interrogate the very architecture of global health research and education.
The Global Health Conference Industrial Complex
Nowhere is performativity more evident than in global health conferences. Panels on decolonization are often dominated by Northern scholars, and when Southern voices are included, they are rarely positioned as epistemic leaders. These gatherings often lack clear theoretical frameworks and fail to articulate concrete strategies for change. They offer catharsis, not transformation.
Without accountability mechanisms and structural shifts in conference design and leadership, these events risk becoming rituals of self-congratulation rather than spaces for critical engagement and solidarity.
A Call for Epistemic Humility and Historical Literacy
Decolonizing global health requires epistemic humility: the recognition that no one has a monopoly on truth or the decolonial agenda. Colonization, and by extension decolonization, is not merely academic; it is historical, emotional, and deeply political. Who then should lead this conversation? Those whose institutions, communities, and bodies bear the scars of colonial violence.
We must learn from resistance movements, such as the anti-apartheid struggle in South Africa, which demonstrated that systemic change is hard, messy, and nonlinear. It requires courage, persistence, and clarity of purpose. The decolonization of global health will not be achieved through hashtags or keynote speeches alone.
Decolonization Without Reform: Why Global Health Keeps Missing the Point
The contemporary decolonization of global health discourse risks becoming performative, rich in language but poor in consequence. While declarations, conferences, and statements multiply, the focus has drifted toward secondary symbols rather than primary responsibilities. Chief among the neglected issues is the accountability of national governments to fund their own research ecosystems and health systems, and to invest politically, not rhetorically, in sustainable health governance.
The field has become overly deferential to declarations such as the Abuja Declaration, Algiers Declaration, and the Lusaka Agenda, treating them as endpoints rather than political tools. History shows that real progress comes not from declarations alone, but from strong political will, leadership, and learning health systems capable of translating evidence into action. Countries that have made tangible gains did so through governance, not slogans.
This performativity is mirrored in global initiatives and convenings. With due respect to efforts such as the Accra Reset, G20 commitments, or ministerial roadmaps on cholera, we must ask whether we are serious. We do not need more research to understand the causes of cholera or how to manage it. What is missing is political prioritization, infrastructure investment, and accountability, not evidence.
A deeper problem lies in the disciplinary narrowness of the decolonization discourse. Global health continues to marginalize historians of science, political scientists, diplomats, and science communicators, placing them at the periphery when they should be central. Decolonization is inherently political and historical. Without these disciplines, the movement remains intellectually thin and strategically weak.
Moreover, leadership of the discourse remains concentrated in Global North institutions, including scholars of Global South origin within them. This raises uncomfortable questions about agenda-setting and whether decolonization risks reproducing power under a new vocabulary.
From Performative Rhetoric to Practical Reform
What then must be done?
First, challenge current funding models that perpetuate inequity. Competitive grant systems favor institutions with existing infrastructure and experience, sidelining emerging institutions in non-English-speaking or underfunded contexts. Funders must adopt flexible models that allow Southern institutions to define their own priorities and pursue context-relevant impact.
Second, build structure and robust theoretical frameworks that clarify why decolonizing global health matters, who should act, and how it should be done. These frameworks must be grounded in lived experience and contextual realities. The time for knee-jerk scholarship in global health is over.
Third, reimagine partnerships based on dignity and mutual respect. Training must be reciprocal, and leadership must emerge from where problems are felt most acutely. Respectful resistance, not deference, should characterize engagement with historically dominant institutions.
Fourth, build a critical mass of Global South scholars who are historically informed, theoretically grounded, and politically aware. Their expertise is not supplementary; it is essential. This requires investment in training, publishing opportunities, and leadership development.
Finally, reclaim agenda-setting power. Research questions, methodologies, and dissemination pathways should reflect lived experience and epistemic traditions of the Global South. Real expertise is grounded in lived experience, not proximity to power. Governments must fund their own research and health systems. Only then can agenda-setting be legitimate and transformative.
And So What?
The way forward is not symbolic inclusion but structural change: rethinking funding models, rewarding impact over optics, centering lived experience as expertise, embracing linguistic pluralism, and cultivating disciplined, theory-grounded scholarship. Decolonization will be hard. But without confronting power, politics, and responsibility head-on, it will remain rhetoric without reform.
The decolonization movement faces substantial limitations. Too often, scholarship is knee-jerk and conceptually thin, lacking clear theory and inclusive voices, replicating the epistemic injustices it seeks to dismantle. South–South partnerships remain inequitable, while English dominates discourse, marginalizing other languages. A small circle of advocates is repeatedly amplified, despite the need for a broader critical mass willing to challenge the status quo. As highlighted in multiple toolkits, true decolonization requires internal mindset shifts, accountability, and collective responsibility, not blame. Its promise depends on disciplined, context-rooted work capable of doing more with less.
Luchuo Engelbert Bain, MD, PhD is a global health strategist and Convener of Global Health Otherwise, a critical platform reimagining global health through equity, power, and accountability. His work challenges performative decolonization, advocates theory-grounded scholarship, and advances African-led, politically informed approaches to knowledge, funding, and health systems reform.