Organised by Shahana Siddiqui, Kristine Krause, Bregje de Kok, Esther Miedema, Anna Wang
26 June 2025
Global health is undergoing significant and critical paradigmatic changes, triggered by (post-)pandemic inequalities, conflicts, increasingly restrictive laws and policies in relation to gender and (women’s) bodily autonomy, climate challenges and decolonization movements. At the same time, efforts to promote global health remain intimately connected to, and dependent on, global financial flows, uneven funding structures and development aid (or the withdrawal and lack thereof). These flows and dynamics profoundly shape the directions taken in, and form of, research collaborations and interventions.
Despite persistent calls for decolonization, global health strategies and policies retain “top-down” approaches, with institutions and actors based in the Global North often taking the lead. However, as roundtable participants highlighted, slowly but surely, realities on the ground and (certain) Southern voices are increasingly centralized. In this moment in time when critical decolonizing approaches are gaining traction in academia and practice, it is a good moment to reflect on the state of global health and its discourses. The following summarizes some of the most salient concerns and insights raised during the round table.
Historians have shown how practices in global health are shaped by intellectual, institutional, and epistemological continuities with its predecessors: international health and colonial medicine. These historical legacies have created path dependencies that frustrate efforts to fully embrace a broad vision of global health and decolonize the field. The WHO adopted the term "global health" to reflect this broader vision, but from the outset, it faced structural limitations in fully realizing its ambitions.
The term “global health” emerged in the 1990s in response to a longstanding crisis within the World Health Organization (WHO), which revolved around a debate about how health should be approached. Some within the WHO advocated for a broad, long-term approach emphasizing social medicine, preventive care, and primary healthcare. Others favored short-term, vertical interventions focused on specific diseases, often with a technical or pharmaceutical emphasis, which were seen as more cost-effective. In response to these crises, the WHO redefined its role, intending to focus more on coordinating global health efforts rather than being the main driver of short term initiatives.
At the same time, the WHO increasingly relied on extra-budgetary funding from sources like the World Bank and wealthy donors from the Global North instead of receiving funding from member states. While in numerical terms, ‘Global South’ actors were in the majority, the changes to funding structures led to institutions such as the World Bank gaining a larger say in WHO's agenda. In short, changes in funding structure and concomitant demands to prove return of investments hampered the WHO’s intended “global” strategy. These changes also restricted WHO’s ability to pursue long-term strategies, forcing it to focus on short-term, measurable interventions. The result was a decentralization of the WHO's role, with many external players becoming involved in global health efforts.
Incorporating social sciences into global health practices presents both significant benefits and notable challenges. There is the danger of overly relying on "blunt instruments"—conventional research methods such as knowledge surveys and rapid assessments. While these approaches can provide substantial data, they often lack a critical perspective and nuance, leading to somewhat superficial insights that overlook cultural complexities of health related behaviours and practices. This in turn, can result in an oversimplified view of ‘ culture,’ framing it merely as an obstacle to health rather than recognizing it as a dynamic factor that influences health outcomes.
Integrating more nuanced, context-sensitive methodologies can benefit health efforts. On the one hand, these methods can help articulate local narratives and lived experiences. For example, during the Ebola crisis medical anthropologists collaborated with organizations like Médecins Sans Frontières to create culturally sensitive communication strategies that encouraged people to seek medical help and follow safety guidelines. By focusing on the lived experiences of individuals and communities, social sciences contributed to more effective responses that respected local customs and improved health outcomes during the crisis. On the other hand, social sciences can help examine the underlying social, political and commercial determinants of health and better understand transnational and national power dynamics that contribute to health disparities. However, overcoming entrenched practices and biases in global health that favor western knowledge remains a challenge.
Decolonizing global health requires more than just addressing the legacy of colonialism; it demands a fundamental shift in how knowledge is understood and valued. Participants suggested that while actors in the Global South may see decolonization as a reassessment of pre-colonial cultural foundations or a challenge to the West, Global North actors tend to approach it quite narrowly, as a means of addressing historical injustices. The multiple ways in which “decolonization” is interpreted and taken up create a disconnect which can rob marginalized participants of the opportunity to have their concerns and desires heard with respect to the meanings at play and the aims that are prioritized. . Meaning is further lost when the notion of decolonization is conflated with concepts like equality, diversity, and inclusion, terms which, in important ways, have been emptied of their political edge.
One roundtable discussant gave an example that emphasized that decolonization requires a deeper critical awareness of power dynamics and epistemological plurality; an attempt to decolonize a European university's curriculum involved faculty engaging students from the Global South in co-designing the curriculum. While the faculty felt positive about this inclusive approach, some Asian students expressed discomfort, as they were unfamiliar with non-hierarchical interactions between students and teachers, which was uncommon in their educational systems. This exercise inadvertently made them feel vulnerable and disempowered. Hence, decolonization must go beyond simply inviting marginalized people to the metaphorical master's house, and instead embrace them on their own terms.
Relatedly, a widely shared concern at the roundtable was tensions between applied and theoretical work in history and the social sciences. Theoretical engagement can be frustrating when it fails to contribute to real change, while applied work is often criticized for not being sufficiently political or critical. That said, discussants were hopeful that academics could contribute to real change by entering the messiness of applied work. In so doing, and as noted above, it is essential to de-centre dominant voices and narratives and centre those that have been historically marginalized. The need for countries in the so-called Global South to articulate their own visions for development was emphasized as a crucial step toward decolonization. Doing so does not mean that institutions in the North withdraw altogether; instead it is about a reframing and rebalancing of roles and relationships and doing so mindful of colonial pasts, ties and legacies.
A recurring theme was the impact of financial and academic structures on global health initiatives. Participants noted that donor-driven agendas often dictate the direction of development, reinforcing existing power imbalances. Academic structures also often perpetuate colonial power dynamics, limiting the representation of diverse perspectives and especially marginalized voices. Critical questions were raised about whose concepts are validated in academic discourse and with which consequences. For instance, when scholars from the global South are confronted with the choice to, either join academic debates in the global North by citing the canon and adopting certain concepts, or not be published and lack funding opportunities.
As for now, whether global health is ‘on its way out’ depends on how we define the term. If we refer to the decline of traditional institutions like the WHO and the rise of private sector influence in global health, then yes, it has been in decline for some time. But if we think of global health as the broad vision articulated in the 1980s (specifically, the Ottawa charter) —one that hitherto remains unfulfilled—then global health is still evolving. Safeguarding the breadth and depth of the scope set out in international agreements such as Ottawa Charter needs particular attention at present.
Participants saw the potential of academic research on Global Health if and when academics dare to step down into the complexities of the real world. Academics need to be willing to learn from concerns within ‘the field’ through ongoing dialogues that bridge the gap between theory and practice. Furthermore, speakers highlighted the importance of recognizing all participants as practitioners in their own right, rather than creating an academic-practitioner dichotomy, emphasizing that everyone has a role to play in reshaping global health. All expressed a renewed commitment to engage in deeper conversations about decolonization and to actively seek out opportunities for transdisciplinary collaboration.
To achieve this end, we explored the idea of creating an "annex" or new wing to the “‘master’s house” of existing academic structures. Whilst we would like to break down the ‘master’s house’, wWe acknowledge that we are inescapably connected to, and dependent on, our established institutions and knowledge traditions. Yet we aspire to create and ‘do’ a space where diverse ideas, languages, and understandings enter, without "othering" historically marginalized ideas and where diverse people can contribute without having to conform to the dominant canon of literature we often feel obligated to cite, generation after generation. We seek to challenge the dominance of Western academic gatekeepers in research and publishing, incorporate so called Southern knowledge systems and learn how to do so in meaningful ways. Doing so is also essential for developing models of and approaches to health and wellbeing that truly reflect the global nature of health challenges.