Grounding the Decolonisation of Global Health within Decolonial Theory
Note: Continuing the Miami Institute forum on “What does it mean to decolonize global public health?,” Sujata Mukherjee responds to David McCoy’s essay, “An Anti-Colonial Agenda for the Decolonisation of Global Health” (October 2023), the essay that launched this forum.
In her response, Mukherjee stresses the importance of grounding the decolonization of global health within decolonial theory and concludes that: “The Global Health industry must open up further spaces for voice, and shift away from the Eurocentric cultures. There should be a continuous reflection of the intersections of power underlying [the politics of knowledge]. What may succeed in reducing oppression somewhere may further it elsewhere, and so these trajectories must be continuously reflected on throughout any attempted decolonial process.” In the coming weeks, this forum at the Miami Institute will come to a close with a virtual discussion among McCoy and respondents to his essay.
Dr. David McCoy in his valuable essay titled “An Anti-Colonial Agenda for the Decolonisation of Global Health” has raised some important issues. I would like to add a few observations in response to his write-up.
It is imperative to ground decolonisation of global health within decolonial theory. As pointed out by Frantz Fanon, decolonisation should mean an entire systemic overhaul which can be accomplished by the removal of the coloniser and dismantling of structures that help to preserve power. Decolonisation must address the pillars of colonialism including white supremacy, racism, sexism and capitalism. In the words of Frantz Fanon: “Decolonization is quite simply the replacing of a certain ‘species’ of men by another ‘species’ of men … Decolonization never takes place unnoticed, for it influences individuals and modifies them fundamentally. It transforms spectators crushed with their inessentiality into privileged actors, with the grandiose glare of history’s floodlights upon them. It brings a natural rhythm into existence, introduced by new men, and with it a new language and a new humanity. Decolonization is the veritable creation of new men. … The ‘thing’ which has been colonized becomes man during the same process by which it frees itself. In decolonization, there is therefore the need of a complete calling in question of the colonial situation. If we wish to describe it precisely, we might find it in the well known words: ‘The last shall be first and the first last’. Decolonization is the putting into practice of this sentence.”
Undoubtedly, a new paradigm is needed to dismantle the concepts of white supremacy, racism, sexism, and capitalism (which exist(ed) as rationalising centres in the formation of colonial epistemologies) and, as such, the neo-colonial situation of the global health industry . Scholars have noted how the global health industry’s predecessors, tropical medicine and international health, existed as tools to extract resources for capitalist agendas. The industry was grounded on the premise of protecting colonisers from rampant, tropical illnesses as they wanted to grab land and resources around the globe.
To begin with, decolonizing epidemiological research is urgently needed. Penetration of colonial and imperialist ideologies in epidemiological research in the past meant dominance of western perspectives and otherization and marginalization of indigenous perspectives and experiences. These disparities and power imbalances are needed to be addressed to promote justice and equality. Decolonisation of epidemiological research would mean increasing the representation of researchers from underrepresented communities, so that epidemiological research is responsive to the experiences of these communities and contextually relevant for approaching the health problems faced by them.
The knowledge and skills of marginalized populations are needed to be recognised, and integrating traditional knowledge—the distinct, culturally specific understanding unique to a particular group—into research efforts should become part of the research agenda. Decolonizing epidemiological research is a process which requires continuing discourse, collaboration, and education.
Decolonizing epidemiological research is an essential aspect of promoting social justice and health equity on a global scale. To advance health equity is immensely pertinent, and epidemiological research is key to understanding the distribution and determinants of health and disease across populations. Epidemiological research perpetuating any form of systemic racism or imperialistic ideologies adversely affect our scientific understanding of disease prevention and control. Like many other fields, epidemiology has a long history of being shaped by colonial and imperialistic ideologies, and as a result, it has often been perceived to further the agendas of the dominant power structures. The practice of ignoring the historical context of colonialism, racism, and other systems of oppression in epidemiological research is unfortunately all too common. Global public health experts have also long recognized that racism perpetuates health disparities which are sometimes embedded in the thrust of epidemiological research.
To decolonize epidemiological research, it is crucial to acknowledge and address these historical and ongoing power imbalances.
The advent of the COVID-19 pandemic also created a space for rethinking the knowledge translation that informs current health policy formulation and planning. Recognition of the failure of global health governance and national health systems has led to calls for reviving the Primary Health Care (PHC) agenda for post-COVID health systems development. This would also require understanding and learning from the politics of knowledge (PoK) underlying global health policy and planning. Failure to address the dominant knowledge paradigm would contribute to its limited application. Access to quality healthcare continues to be a distant, unaffordable goal for the majority of the world. Inequalities in health indicators and inequities in access to health care are growing over the years.
Knowledge plays a pivotal role in policy-making and governance. The application of PoK as an analytical lens helps understand the power equations underlying the process of knowledge generation and its translation into policy and practice. The foundations and assumptions underlying the dominant ‘knowledge’ system, which basically shape techno-centric and commodified health system are needed to be interrogated. The world can be empowered to respond better by engaging with diverse ontologies and epistemologies to conceptualise knowledge and frame policies. In the contexts of Asia, Africa and Latin America in particular it can contribute to the development of self-reliance to democratize general health policy and planning in the post-pandemic period. Biomedical, epidemiological, social, and systemic knowledge is further mediated by technological, institutional, normative, cultural, political, and financial factors in the process of knowledge translation for its implementation. The diverse knowledge sources and their framings receive differential patronage from the state, the market, and powerful technical professional groups leading to hierarchical relations. Despite the plurality of knowledge traditions related to human health, the prevailing dominant paradigm legitimised by the state, market, and technical professionals shapes societal acceptance of a particular form of knowledge creating an apparent hegemony. The Foucauldian proposition of ‘knowledge as power’ is pertinent for this PoK.
Thus, knowledge translation in public health research is not merely about communicating research knowledge to policymakers and governance actors. Rather its broader conceptualisation raises questions such as: Are existing methodologies of knowledge generation and assessment of what constitutes proof or legitimate evidence appropriate for different forms of knowledge in health? Does knowledge translation lead to structural devaluation of certain types of knowledge over others? Does evidence-based practice mean ruling out experiential knowledge possessed by the practitioner in the field and of the so-called ‘non-scientific’ people? PoK is a field of enquiry that engages with these questions, drawing on insights from a range of disciplines including sociology, science and technology, political science and philosophy.
Scholars have theorised how today we have entered an era of ‘biocapitalism;’ specifically, before health equity can be discussed, the health of a body must first be made available to capitalism as an object of intervention. The global health industry’s priorities are determined by and for the richest and most powerful nations. This has been demonstrated by the current COVID-19 pandemic and the inequities in the production and distribution of vaccines. Pharmaceutical monopolies and intellectual property restrictions have caused significant shortages and restrictions. A waiver of such intellectual property restrictions has been opposed by large pharmaceutical companies and rich nations. The COVID-19 pandemic has again demonstrated how white supremacy, racism, sexism and capitalism still remain tied as central, rationalising logics for the global health industry.
In addition to Fanon, it may be helpful to engage other social theorists in their attempts to analyse oppression and power in conceptualizing decolonization. First, Michel Foucault’s analyses of power may be useful to think with to understand how power functions within the global health industry. Specifically, Foucault speaks of the emergence of ‘biopower’ in the ability of governments—national or otherwise —to make worthy populations live and let unworthy populations die. Achille Mbembe speaks of necropower. The Global Health industry must open up further spaces for voice, and shift away from the Eurocentric cultures. There should be a continuous reflection of the intersections of power underlying PoK. What may succeed in reducing oppression somewhere may further it elsewhere, and so these trajectories must be continuously reflected on throughout any attempted decolonial process.
-Sujata Mukherjee
Professor Sujata Mukherjee is currently Professor of History, Rabindra Bharati University, Calcutta, West Bengal, India. She teaches modern and contemporary History including history of Science, Technology, medicine, Environment, Women’s history, Social , cultural and Political history of Modern India. She held the post of Dean, Arts Faculty of Rabindra Bharati University and was Director of Centre for Gandhian Studies for several years. She had also taught at the Victoria University, Wellington, New Zealand, as ICCR Chair for Indian Studies and remained attached to different organisations and institutions as visiting faculty, researcher in and outside India including the Wellcome Trust Centre for History of Medicine, London, Rockefeller Archive Center , New York, Jawaharlal Nehru University, New Delhi, Indian Institute of Science, Bengaluru, and delivered invitational talks at conferences and seminars held in different parts of the world. Recently she designed and co-ordinated as well as taught a course on Science, technology and Society for MTech students of 2 Year MTech Course on Science Communication for Engineering graduates and Science post-Graduates offered by National Council of Science Museums (NCSM)working under the Ministry of Culture, Government of India.
Professor Mukherjee has published extensively on different aspects of history of science, medicine and environment. Some of her recent important publications include books and monographs like Situating Tagore’s Environmentalism: Environmental degradation and Rabindranath’s activism, Germany: Lambert Academic Publishing, 2012; Gender, Medicine, and Society in Colonial India Women’s Health Care in Nineteenth- and Early twentieth-Century Bengal. New Delhi: Oxford University Press, 2017 and book chapters and essays in Journals including: “ Ayurvedic Medicine in Colonial Bengal: Challenge and Response”, Syed Ejaz Hussain and Mohit Saha( Eds.) India’s Indigenous Medical Systems: A Cross-Disciplinary Approach, New Delhi: Primus Books, 2015, “What did the ‘wise men’ say? Gender, sexuality and women’s health in colonial Bengal” in Biswamoy Pati and Mark Harrison edited, Society, Medicine and Politics in Colonial India, Routledge (India),2018; “Family Health and Dissemination of Medical Knowledge in Nineteenth century India” in Bipasha Raha and Subhayu Chattopadhyay edited Mapping the Path to Maturity: A Connected History of Bengal and the North-East, New Delhi: Manohar, 2018; “Medicine and Public Health in Modern Bengal, 1850-1950”, in Late Sabyasachi Bhattacharya edited, A Comprehensive History of Modern Bengal,1700-1950(Vol 2),The Asiatic Society, Kolkata in association with Primus Books,2020;”Lock Hospitals and Venereal Diseases in Nineteenth Century Bengal”, in Suvankar Dey(ed.),Health has a History Revisiting Bengal,Kolkata:K.P.Bagchi&Company,2021,”Imperialism, Medicine, and Women’s Health in Nineteenth-Century India” in Bhaswati Chatterjee and Aparna Bandyopadhyay(ed.), Her Story Essays on Women’s History in Honour of Professor Geraldine Forbes, Kolkata:Sampark,2022,pp.277-“Smallpox and Children in Colonial Bengal: Revisiting a Virulent Epidemic”(co-author), in Journal of the Asiatic Society , Volume LXII No.4 2020,pp.147-162.She is currently working on History of Epidemics in Modern South Asia and editing a book tentatively titled: Microhistories of Medicine: Making of Modern India
