The Lancet Journal

COMMENT| VOLUME 398, ISSUE 10312, P1673, NOVEMBER 06, 2021
Offline: The myth of “decolonising global health”
Richard Horton
Published:November 06, 2021
DOI:https://doi.org/10.1016/S0140-6736(21)02428-4
PlumX Metrics

The Lancet's inaugural issue was published on Oct 5, 1823. In his opening editorial, Thomas Wakley, our founding Editor, described the journal's intended audience: London's physicians and surgeons; country practitioners; medical students; and, rather ambitiously, “every individual in these realms”. Wakley also hoped to reach a fifth category of readers—“Colonial Practitioners”. The Lancet was born as a product of colonialism and, at least in part, as an instrument to support and advance British imperial objectives. This history is important to recall because of the growing movement to decolonise medicine and global health—a project, according to Eugene Richardson's definition in Epidemic Illusions (2020), to “reject the notion that social inquiry can produce objective, value-neutral, and univocal understanding”. The legacy of colonialism still casts a humbling shadow over The Lancet today. I remember a meeting in Delhi several years ago between editors and the authors of a series of papers on India's health system. As we began to discuss the suggestions of peer reviewers, one author halted the proceedings. He said that he was not willing to engage with criticisms from western critics invited by a journal complicit over many centuries in oppressing his country and his people.
In his 1994 book, African Philosophy in Search of Identity, D A Masolo traces the origins of western attitudes towards Africa to the beginnings of the birth of science. Early philosophers of the Enlightenment argued that Africans lacked reason, and without reason they must also lack history, development, and culture, thereby denying them access to the intellectual and scientific revolutions taking place across 17th-century Europe. Only relatively recently, beginning with Cheikh Anta Diop's The African Origin of Civilization (1974) and Martin Bernal's Black Athena: the Afroasiatic Roots of Classical Civilization (1987), were three centuries of exclusionary thinking seriously challenged. But over that period, irreparable damage had been done—and continues to be done. As Kehinde Andrews writes in The New Age of Empire (2021), “The primary logic underpinning the Western world order is that Black and Brown life is worth less.” Western scientists like to believe that they and their forebears have played a benevolent part in shaping the success of modern civilisation. By contrast, Andrews argues that the true foundations of western culture lie in histories of genocide, slavery, and colonialism: “Violence was the key ingredient in establishing Western empire.” We see the consequences of these histories today. The present humanitarian emergency in Afghanistan can be traced back to the chaos left after the UK's three 19th-century Anglo–Afghan wars. The UK's imperial ambitions—to use Afghanistan as a buffer against Russian expansionism to protect its Indian empire—betrayed the Afghan people then, just as we have betrayed them in the 21st century after promising peace, freedom, and security.
Medicine and global health continue to be entangled with colonial attitudes, structures, and practices—from scientific journals to research funders, from top universities to respected academies, and from influential philanthropies to multilateral agencies. Decolonisation seems an urgent obligation if those who advocate for equity wish to be taken seriously and retain even a vestige of moral conscience. But the project of decolonising global health possesses a tragic flaw. For when an Empire falls, it does so only to be replaced by another Empire, one often more insidious and dangerous than its predecessor. The idea that one can purge global health of colonialism is a comforting but deceptive myth. The modern age of colonialism is embodied in a powerful group of nations, together with the organisations that represent them—the permanent five members of the UN Security Council, the G7, the G20, EU27, the World Bank, and the International Monetary Fund. Kwame Nkrumah, after leading Ghana to independence from the UK in 1957, wrote that “The neocolonialism of today represents imperialism in its final and perhaps its most dangerous stage.” As medicine and global health struggle over decolonisation, we need to undertake a more realistic and rigorous analysis of where power lies politically, economically, militarily, and culturally. Changing the names of buildings and removing statues of scientists whose pasts we now deem unacceptable, as important as these symbolic measures might seem, risk becoming illusions of action, veiling the truth concerning new regimes of authority, dominance, and privilege. Decolonisation must mean much more.

https://www.thelancet.com/journals/lancet/article/PIIS0140-67362102428-4/fulltext

That's from last November. I may have posted it before. The "Capitalism, not Racism", response only appeared in the latest edition.