The issue
The movement to “decolonize” global health1 has gained traction in recent years. For centuries, the legacy of colonialism has continued to shape the health outcomes of those in developing countries. To decolonize healthcare means making it more accessible to those that are marginalized by existing systems. This can involve rectifying the hidden costs of health insurance, discouraging the unsafe use of nutritional supplements, and improving access to healthcare in underserved areas.
Hidden costs of health insurance
A recent working paper details gender disparities in the utilization of government health insurance in India. Though this program was meant to offer free healthcare, patients reported paying unauthorized out-of-pocket charges for services. This disproportionately affected women, whose share of visits declined by almost 4 percent for every 1,000 rupees charged. Women’s visits also decreased for every 10km increase in their journey to the nearest hospital. Such hidden costs create barriers for those that are in most need of subsidized healthcare. Thus, to offset these costs, the authors recommend more gender-targeted efforts such as female-specific transport assistance and care subsidies.
Unsafe use of nutritional supplements
In the 1970s, infant formula companies began marketing in low and middle-income countries. These marketing practices promoted formula as nutritionally superior to breastmilk, failing to highlight that formula prepared with unclean water could act as a disease vector. Using a combination of historical sources, this study uncovers that infant mortality increased by 27 percent in households with unclean water following the introduction of infant formula. This mortality effect was higher among mothers that were less educated. As it stands, women and children are the most marginalized in healthcare. To close these gaps, health interventions moving forward should prioritize exclusive breastfeeding practices to ensure developing countries do not miss global nutrition targets.
Access to healthcare in underserved areas
Though colonial institutions have a legacy of perpetuating health disparities, one study in India shows that this may not always be the case. In the late 19th century, the number of Protestant medical missions surged in non-Christian areas to facilitate evangelization. To this day, these mission hospitals are among the largest healthcare providers in India. This study correspondingly finds that proximity to one of these facilities has a positive effect on individuals present day BMI and other health outcomes.
Furthermore, the authors uncover that these results are driven by changes in hygiene practices rather than the persistence of infrastructure. Specifically, living close to a village with a historical medical facility increases a household’s probability of treating water significantly. However, researchers also mention that these missions settled in densely populated areas with better access to railways and water sources. This suggests that those living in historically less affluent areas benefit less from these changes in health and hygiene, highlighting the need for improved healthcare access in underserved areas.
Closing thoughts
According to Seye Abimbola, professor of global health at the University of Sydney, it is not possible or advisable to see 'decolonizing global health' as one movement. That is, the process of addressing the power imbalances in healthcare is complex and multifaceted, and will require a multitude of strategies in order to break ground moving forward.
Decolonizing global health refers to “reversing the legacy of colonialism in health equity work.”