LAUSR

Correspondence to Dr Mark Hellowell; mark. hellowell@ ed. ac. uk © Author(s) (or their employer(s)) 2022. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Calls to ‘decolonise’ global health have intensified in recent years, as reflected in the rapid growth of the academic literature on this concept. This body of work (henceforth: ’the literature‘) draws on the conceptual frameworks and interpretive lenses of Critical Race Theory and related analyses of structural racism in Western countries 7 8 alongside postcolonial theory and related analyses of colonialism’s cultural, psychological and material impacts and legacies, especially in the ‘Global South’. 10 The literature calls attention to asymmetries in the distribution of epistemic authority and decisionmaking power in global health and argues that these have their origins in colonialism and continue to advantage and empower some persons over others, depending on their race, ethnicity and place of origin with the disadvantaged group comprising Indigenous communities and ethnic minorities in the 'Global North', and black people and people of colour in the 'Global South'. 12 There is a range of different arguments about the best methods for addressing these asymmetries. Authors affiliated to the Global Health Decolonisation Movement in Africa emphasise the urgency of the need for change, and argue for reforms that are discrete, tangible and measurable. Others make the case for deeper, more systemic, and perhaps more ambiguous approaches to reform—including, in the case of one article, the ‘complete overhaul’ of global health, including ‘removal of the coloniser’ from the discipline. Despite these differences, a number of analytical tendencies are common across the literature, three of which provide our focus in this commentary. These relate to: knowledge (the argument that global health favours ’Western‘ forms of knowledge and marginalises others); universalism (the argument that global health is defined by a ‘Eurocentric’ conception of humanity which is incomplete, partial and unjust); and purpose (the argument that the purportedly colonial origins of global health are retained in the contemporary structures and practices of the field). In this commentary, we define ‘global health’ as an endeavour that aims at the worldwide improvement of health; and ‘global health institutions’ as the entities primarily concerned with advancing this aim. We recognise that the decolonialist critique has the potential to stimulate a redistribution of epistemic authority and decisionmaking power in global health and by doing so enhance its potential to ‘do good’. But we have also identified a number of potential harms, by: (i) undermining confidence in scientific knowledge; (ii) accentuating intergroup and international antagonisms; and (iii) by discounting the degree of progress already achieved that may curtail opportunities for redistributive change in the future. Summary box