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Correspondence to Dr Shahzad Amjad Khan; drshahzad. amjad@ gmail. com © Author(s) (or their employer(s)) 2022. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION The last few years have witnessed a renewed consciousness and increasing calls for ‘decolonising’ global health. The COVID19 pandemic coincided with this increased awareness and demand for change by exposing the deeprooted inequities, biases, elitism and racism that plague global public health. Building on this sentiment, there have been calls for putting rhetoric into action towards achieving meaningful decolonisation of global health. 6 There is now an ongoing debate about the best strategies to eventualise such decolonisation. In this debate, positions may be classified into four approaches. These include the ‘metricsoriented’ approach that stipulates the need for metrics to aid the process of decolonisation; the ‘pragmatic’ approach that demands broad based, though arguably enforceable changes that cut across the global health landscape; the ‘epistemologyoriented’ approach that situates the decolonising endeavour within an established framework of decolonial philosophy, and the ‘partnershipsoriented’ approach that calls for power and privilege sharing across the global health landscape. 9 Each approach has its particular strengths just as each has its own blind spots. Sustainable progress towards decolonisation will require some form of measurement. However, such metrics would have to be carefully crafted and consist of a mix of qualitative and quantitative elements— all designed with a view to engage creators and users of knowledge in meaningful and sustained reflexivity. Epistemologyoriented approaches correctly identify the root cause of colonialism and dominance in patterns of thought. But embedding the decolonisation discourse within paradigms of decolonial philosophy laden with complex language and terminology may make the discourse inaccessible to the majority of people disenfranchised and affected by colonialism. By shifting the power of analysis back to the erudite elite, epistemologyoriented approaches may inadvertently exclude the masses, and can also paralyse direct decolonising action by extending the decolonisation process towards an infinite horizon. The pragmatic approach realises the urgency of decolonising action. However, this urgency leads to proposals for actions that may be difficult or impossible to enforce. This can have the unwanted effect of shifting focus away from immediately attainable targets. Finally, proponents of a partnershipsbased approach 9 propose NorthSouth partnerships and a ‘leaningout’ strategy to distribute power and dilute privilege. This approach, while noble, seems to miss the fact that, at present, all incentives are aligned against Summary box