Decolonising medicine and health: brave, hopeful, and essential

Liam Smeeth is director of the London School of Hygiene and Tropical Medicine, a white Englishman helping one of the world’s foremost global health research institutions face up to its colonial roots and legacy (doi:10.1136/bmj.p2232).1 The very founding basis of LSHTM was to prop up and extend colonialism. Is he part of the problem or the solution? Should he make way for somebody more representative of the communities that LSHTM works with?

I’m from a former colony, now editor in chief of a journal that undoubtedly built its status, influence, and wealth from the fruits of empire—and continues to thrive on the advantage that colonial power delivered. I know all too well the ongoing effects of colonialism on people and nations that were colonised and that, although no longer colonised in law, remain colonised by economics, politics, and inequities. Does that make me a hypocrite, a sellout?

Lara Akinnawonu is an early career doctor in the UK with a firm belief that the BMA, her medical trade union, “must examine its history and current structures and policies through a decolonial lens” (doi:10.1136/bmj.p2337).2 The more we talk and understand racism, says Akinnawonu, the more we appreciate its ties to colonial legacies and the urgent need to decolonise for the benefit of disadvantaged communities. Those efforts must begin with medical education and training (doi:10.1136/bmj.p2294).3

Seye Abimbola is editor of BMJ Global Health, a Nigerian working in Sydney, who is critical of institutions from rich countries setting up country offices as they seek to internationalise. By doing so they destabilise the local ecosystem. “The BBC, for example, can never do for Nigeria what it does for Britain,” he says. “That is very colonial, in my view” (doi:10.1136/bmj.p2257).4

Muneera Rasheed is a researcher in early childhood development from Pakistan. Rasheed’s argument is that a simplistic partnership model is an insufficient response to colonialism, because colonialism “reproduces itself” by incentivising the empowerment and privilege of those who work with decision makers in “coloniser countries” (doi:10.1136/bmj.p2256).5 Colonialism begets colonialism.

Partnerships must be built on humility, a willingness to learn, and a shift of power to individuals and institutions in “global majority” countries. Rasheed posits that such a power shift is the only path to take, whether she lives to see it reach its destination or not. This echoes conversations with our regional editorial boards for South Asia and Africa, about how we work with them to improve health and wellbeing in their regions without our own effort being colonialism. As my colleagues who compiled our series of articles and podcasts on decolonising medicine and health write, “We expressly do not view ourselves as experts but as allies” (doi:10.1136/bmj.p2302).6

Yet there is another theme to Rasheed’s analysis that represents the nature of many people disillusioned with the division and conflict that result from today’s, often subtler, colonialism. It is the ability to see fault in ourselves, to be critical of our societies and our leaders, and not be divided and ruled on the basis of race, religion, and politics. We see it in the community organisations fighting for the rights of marginalised populations in every country.

We see it most starkly today in the supporters of Israel around the world who are willing to condemn and demand an end to the conflict in Gaza, with its impact on health services and humanitarian rights (doi:10.1136/bmj.p2383 doi:10.1136/bmj.p2397).78 WHO has recorded over 50 attacks on healthcare facilities in Gaza over the past 11 days (doi:10.1136/bmj.p2423).9 We see it in supporters of Palestine willing to condemn Hamas’s attack on Israel as terrorism. We see it in people across South Asia speaking up, at considerable personal risk, for minorities being persecuted for religious beliefs.

Violence begets violence, and the flames of hatred are easily fanned, when peace is the better, and possibly braver, strategy. There is a moral duty on international organisations, leading nations, and health professionals to demand an immediate ceasefire in Gaza and repatriation of hostages, restore basic human rights and access to humanitarian relief, and advocate unapologetically for peace. One way forward is to meaningfully explore mechanisms for health, peace, and development in a region that continues to struggle with the legacy of colonisation. The words of health professionals from across South Asia are also relevant here: “Now, more than ever, we need to join hands to support our shared humanity and shape a new future for generations to come” (doi:10.1136/BMJ-2021-067384).10

Colonialism is complex. It is driven by power, politics, prosperity, and prejudice. The UK, US, Spain, and France, some of the countries most criticised for colonialism, were once colonies themselves. Colonialism today is no longer manifested in direct rule but in the soft power of economic dependence and military superiority—take China’s belt and road initiative as an example. The solutions, therefore, are complex and multilayered.

But it is the brave people willing to say enough is enough to colonialism and abuses of power, by their own nation and leaders, and to confront the consequences of their historical and current advantage who carry the hopes of our world with them. This is an important element of efforts to decolonise medicine and health. “One of the fundamental principles of decolonisation,” says Zulfiqar Bhutta, “is that you give equal weight to the quality of life and to the rights of all populations.”4

Amen. Ameen. Tathastu. Aye.