Jens Holst1
Abstract
Background: In recent years, the discourse surrounding the decolonisation of global health has gained significant traction, fuelled by a renewed interest in addressing historical inequities rooted in colonial legacies. Nevertheless, the present discourse on decolonisation evinces a certain degree of selectivity and conceptual reductionism, overlooking important structural and geopolitical dimensions.
Methods: An explorative narrative literature review was performed between January 2025, and April 2026, encompassing a comprehensive search strategy across relevant health sciences databases, including PubMed, Scopus and Web of Science. In addition, the review expanded beyond conventional health-related literature to include social science, history and other databases, along with grey literature sources, thereby ensuring a multifaceted exploration of the subject matter. The initial findings were supplemented using citation tracking and snowball searching, including publications in languages other than English, namely Spanish, Portuguese, German and French.
Results: The examination of the socio-political and economic dimensions of the colonial legacy points to several critical gaps in the current decolonisation discourse, particularly with regard to the relative marginalisation of perspectives from Latin America. Beyond rather technical challenges, three gaps emerge as essential for decolonising global health. Firstly, contemporary decolonisation efforts frequently reflect a Eurocentric perspective predominantly shaped by scholars from the Anglophone Global North, often neglecting the dynamics and implications of internal colonialism. While aiming to dismantle historical injustices and power imbalances, these approaches insufficiently address the role of domestic elites in sustaining neocolonial dependencies. Secondly, the decolonisation discourse in global health remains heavily Anglo-Saxon in orientation, marginalising diverse geographic regions, epistemologies, and ethnic perspectives. Thirdly, an examination of the intersection of race, capitalism and colonialism reveals insufficient attention being paid in the decolonisation debate and practice to the framework conditions. These are increasingly set by the neoliberal, increasingly feudalist global economic order and its role in reproducing and perpetuating health inequalities.
Conclusion: This review calls for a critical reassessment of dominant paradigms in global health decolonisation, emphasising the need for systemic transformation that takes account of the historical, geographic, ethnic and socio-political complexities. Greater attention to internal colonialism is imperative for decolonising global health, alongside the inclusion of marginalised voices and perspectives. Promoting a more equitable and comprehensive landscape requires a transformative approach that addresses the structural drivers of global health, including the economic and commercial determination of health, and challenges the broader conditions that sustain inherited inequality.
Keywords: Decolonisation, global health, coloniality, decolonising, internal colonialism, racism, capitalism, neoliberalism, refeudalisation