By guest contributors Malvikha Manoj, MSPH; Hloni Bookholane, MBChB MPH; Reiner Lorenzo Tamayo, RN; Ghiwa Nasser Eddine, RPh, MPH; Magali Collonnaz, MD…
By contributing author Ijeoma Nnodim Opara, MD
“For the master’s tools will never dismantle the master’s house. They may allow us to temporarily beat him at his own game, but they will never enable us to bring about genuine change…I urge each one of us here to reach down into that deep place of knowledge inside herself and touch that terror and loathing of any difference that lives here. See whose face it wears. Then the personal as the political can begin to illuminate all our choices.”
― Audre Lorde
These days, one can barely throw a stone in a global health space without hitting something to do with decolonizing global health. The decolonization of global health is the latest topic du jour and everyone is an expert. From blog posts to journal articles and webinars to conferences, the calls to decolonize echo throughout the cybersphere of institutions in the Euro-American region, twirling in and out of social justice conversations and dancing on the edges of diversity, equity, inclusion (DEI) discourse.
“Global health must be decolonized!” is the growing call to action.
But, how? And do folks understand what the term ‘decolonization’ actually involves?
Is decolonization even possible especially if the same tools and systems of colonialization are employed in attempts to decolonize? Have global health actors reached down into that deep place of knowledge to touch that terror and loathing of difference?
Whose face does it wear?
Some of us in the global health space who were flying the banner of decolonization long before it became lit to do so, have looked upon the growing decolonization movement with mixed feelings and a lot of discomfort.
On the one hand, we see the need for greater awareness about the lasting damages of colonialism, and the power asymmetries that are pervasive in global health. On the other hand, our unease can be categorized in to three concerns:
How is coloniality showing up in the decolonization movement?
Decolonization is often perceived as a means to uncover the histories of the colonized, those whom Frantz Fanon refers to as the “Wretched of the earth”, and bring their stories to the awareness of the mainstream. However, it is often confused with any social justice endeavor including diversity, equity, and inclusion and often devoid of a critical analysis of power, history, and sociopolitics. This lack of critical introspective analysis of power, hegemony, and the historical and continuing dynamics of internalized and systemic oppression in contemporary health and higher education structures, results in the reproduction of colonial logics of commodifying human beings, labor, space, and knowledge.
What this looks like is the maintenance of a power hierarchy in global health that is still predominantly white, cis-gendered, heterosexual, male, and European/American. It looks like institutional-community or (neo)colonial-(neo)colonized processes, practices, and policies of funding, partnerships, and program/project development that replicate colonial dynamics of extraction and exploitation. It looks like curricula that re-marginalize, de-prioritize, and minimize the lived experiences, expertise, and epistemologies of indigenous communities. It looks like narratives that obscure the interdependent causative relationship of the development and wealth of Europe and North America and the under-development and poverty of their past and present colonies. It looks like discourse that ignores the role of (neo)colonizer economic and national security decisions and policies that suppress indigenous independence. It looks like co-opting and bending the decolonization discourse to adhere to Eurocentric constraints such as viewing situations in binary terms and, therefore, in “tension” versus in multifaceted, intersectional, and in harmony. Constraints such as framing approaches as pragmatic vs philosophical as opposed to each informing and depending on the other. It looks like language that reinforces the hegemony of Europe and North America over the rest of the word such as “Global North” and “Global South” or defining nations by economic status set to Euro-American indices of prosperity and development. It looks like the absence of a commitment to justice and engagement with community-led justice and liberation movements.
Who is the decolonization movement for?
We have observed a lack of reference and deference to Majority World scholars, thinkers, practitioners, and activists in the rush of Euro-American do-gooders to institutionalize decolonization centers, departments, positions, apply for grants, and create programs, projects, and curricula. This ironic rush to colonize the decolonization movement is done without reflecting on (neo)colonizer intellectual connectivity to indigenous and majority world critical inquiry, often as a result of ongoing epistemological exploitation.
Giants such as Aime Cesaire, Frantz Fanon, George Sefa Dei, Chizoba Imoka, Ngugi Wa Thiong’O, Amilcar Cabral, Es’kia Mphahlele, and many others are omitted from discourse as institutions mobilize to incorporate “decolonization” studies into their neo-liberal academic framework. Institutional norms, epistemologies, ontologies, praxes, policies, and processes built on Euro-American neo-liberal values of the hierarchical dualism of the individual over social, human over environment, and industrialized or “developed” over non-industrialized are expected to embrace what Tshepo Madlingozi and Frantz Fanon describe as a violent and disruptive process, and what Joel Modiri defines as “…an insatiable reparatory demand, an insurrectionary utterance…It entails nothing less than an endless fracturing of the world colonialism created.”
The attempt to incorporate the disruptive violent process of undoing colonization within colonial frameworks and matrices is itself an act of colonization as it ignores the inherent intent of decolonization and presents as an unwillingness or an inability to change. It is also emblematic of the ego-centrism and lack of self-introspection that often peppers well-intended decolonization actors and their actions. Often, they do not do the work of reaching down into that deep place of knowledge inside oneself to touch that terror and loathing of any difference that lives there, and see whose face it wears, so that the personal as the political can begin to illuminate their choices. Often, they do not submit themselves to the endless personal and political fracturing that is decolonization. The urgency dictated by white guilt leaves little space and time for actual reflection, deconstructing, deconditioning, relationship-building, and structural dismantling. Thus, grassroots indigenous and Majority World leaders are left in the dust, their ideas co-opted in the rush to “solutions”, while colonial power paradigms and dynamics are left intact, patterns of oppression and structural injustices remaining unfettered and reinforced.
What about intersectionality?
Anchored to the first two concerns, the lack of a critical power analysis rooted in indigenous and Majority World critical inquiry renders the decolonial movement impotent to actualize real fundamental change. This is because a critical analysis of colonialism is fundamentally intersectional and must locate its construction, and thus, deconstruction, at the intersection of white supremacy, global anti-Blackness, patriarchy, capitalism, ableism, classism, homo/transphobia, fatphobia, and xenophobia. It is George Sefa Dei and Chizoba Imoka who state that ‘To colonize … one has to equate the purpose of life to material acquisitions, affirm their personhood only through their ability to dominate/bully others, shrink their mental capacity so as not to respect/understand human diversity and rationalize a wide range of unfettered violence.’ A decolonization movement that is not intersectional and does not contend with these mutually reinforcing interdependent systems of oppression and violence in the structural, interpersonal, and internalized dynamics of global health is doomed to fail. The lack of courage to name these intersectional systems of oppression, the paradigms of structural violence that undergird our global health institutions, and call out their perpetuators and benefactors allow these systems to persist un-checked, in so-called decolonization spaces.
The bottom line is that the decolonization movement itself needs to be decolonized. We cannot decolonize global health using the same logics, dynamics, and paradigms that birthed it in the first place. We cannot dismantle the master’s house with the master’s tools. Unfortunately, many decolonization scholars and advocates, especially in academia are shackled into inaction, as the only tools at their disposal are the same tools of colonialism, the same system into which we have all been baptized. Which is why many anti-colonial thinkers have expressed that decolonization is impossible, but, in the words of Foluke Ifejola, “…we must make her possible if we wish to survive this wretched night that this wretched earth has been plunged into by humanity.”
This will require an imagination revolution. A liberatory mindset reset. A paradigm cataclysm.
We must de-construct and re-construct global health spaces using transformative tools created by indigenous, grassroots, and majority world communities. The voices of the poorest, darkest-skinned, most disabled, women (cis and trans), and femmes must be centered at decision-making tables in policy, education, health, economy, & Justice. Tables built by them for them.
Nothing about them without them.
We make decolonization possible by:
- Getting comfortable with multiformity and fluidity: Decolonization has multiple definitions and that’s okay. The complexity of the concept, process, and movement allows it to accommodate multiple definitions even as its meaning shifts depending on the sociopolitical positionality of the actor, the positionality of their audience, the actor’s geographical and epistemological location, their colonial history, their role inside or outside academia/activism/politics, and their access to power. It is a colonial construct that everything has to be rigidly defined and have only one definition. The fluidity of decoloniality allows for a multi-faceted approach to decolonization so that various aspects of the colonial mountain could be attacked simultaneously and synchronously, increasing the likelihood of it being successfully leveled.
- Ground decolonization in the work of Majority World leaders: The voices of indigenous and (neo) colonized decolonial and anti-colonial liberation movement scholars, thinkers, strategists, and activists must be centered in all decolonial efforts. Their perspectives, lived experiences, expertise, and knowledge systems come first and must inform all other work. They must inform language, stance, frameworks, and strategies. Funding and infrastructural support must be provided to these indigenous and (neo)colonized communities to power their strategies and solutions towards liberation, autonomy, and independence. They must inform what success looks like and what those metrics are. Intentionality should be performed towards ensuring that Majority World decolonial, anti-colonial, and liberation leaders who are women, LGBTQIA+, and disabled occupy the forefront of the movement.
- Center Intersectionality and interdependence: Health does not exist in a vacuum and the health of communities all over the world are informed by social and structural determinants including neo-liberal economic world trade policies that produce and reproduce national poverty, reinforce dependency and neo-colonialism, and lead to poor health outcomes domestically and internationally. These dynamics of exploitation and extraction, which created the conditions for Europe and North America to develop and prosper on the back of Africa, were established during the Atlantic slave trade and colonialism and maintained today within the systems of capitalism, patriarchy, ableism, homo/transphobia, xenophobia, racism, white supremacy, and anti-Blackness. The decolonization movement needs to integrate with movements working to dismantle these intersecting systems of oppressions which undergird coloniality in global health and beyond. Which is why calls to return stolen lands to indigenous communities and pay reparations to the colonized, disenfranchised, racialized, and oppressed must be integral to global health decolonization movements. Similarly, human health is interdependent on the health of animals, plants, the environment, and the plant, which informs the economy and sociopolitical landscape of any society. An intersectional lens is critical to decolonization.
- Emphasize a critical analysis of power: Power is fundamental to colonialism, neo-colonialism, and coloniality. Critical introspection as to how individuals as part of institutions, as well as the institutions themselves, produce, re-produce, maintain, and benefit from intersectional systems of oppression within a colonial framework is necessary for decolonization to be realized. What this means is that Euro-American people and the systems they represent and uphold need to divest from power-hoarding and lean out of power and privilege to allow indigenous and Majority World people thrive. While the formerly colonized and neo-colonized lead, the former colonizers and neo-colonizers need to actively dismantle the structures of oppression they created, inherited, maintain, and from which they benefit. This not a light proposition as it will require (neo)colonizers to divest from the very definition of themselves, as their identities were constructed on the basis of dominance acquired through bloody violence, rape, genocide, enslavement all to concentrate power and resources. To divest from an identity that sits at the intersection of coloniality and whiteness will require a fundamental existential shift in consciousness, imagination, decision-making, and politics that sets the (neo)colonizer free from the bondage of their addiction to power and the lies constructed to preserve the un-earned position of power in the social hierarchical house of cards. The challenge would be in the novel act of crafting an identity independent of dominance and oppression.
- Return to the Source and Prioritize it: This section is especially and lovingly written to my people, the “unassimilable Majority” – the indigenous, formerly colonized, and (neo)colonized. Ultimately, decolonization should be defined by, led by, and the benefits reaped by who Es’Kia Mphahlele refers to as the “unassimilable Majority”. To overcome colonization and achieve decolonization and liberation, we, the Majority people, would need to reject the external as well as the internalized white Euro-American gaze and standards and “return to the source”. This means that we must make the journey into our individual and collective self to recover, reclaim, and restore our indigenous cultures, epistemologies, languages, technologies, art, histories, religions, and science. Our stories. Our identities. Our essence. We must name ourselves and own our narratives. We can position ourselves to speak truth to power through taking pride in the complex beauty of our languages. We can create our own definitions and correct the terminologies that reinforce global hegemony and dominance such as “Global North vs Global South” which are alternative terms for “First world vs Third World” or “Developed vs Undeveloped”, “The West vs Non-West”, “Sub-Sahara vs Super-Sahara?” and other inaccurate, homogenizing terms that were not created by us nor do they represent our reality, ethos, values, and priorities. We can embrace our heterogeneity as strength and re-discover how our indigenous knowledge, resource, and belief systems can inform the structures of our sociopolitical organization. We can remind ourselves that (neo)colonized regions developed and continue to develop the colonizing regions and recognize that their wealth and development is a result of continuing practices and policies designed to exploit and extract from our resource-rich settings. It is also important to note the neocolonial puppet-mastery that use so-called indigenous political leaders and manipulate internal sociocultural and economic dynamics to obscure their continuous plunder of our lands and resources. This acknowledgment is important in framing our own home-grown strategic solutions to achieving true independence and liberation from all forms of oppression. Firstly, liberation begins in our own imagination, in our own individual and collective selves before it can be translated externally. Our possibilities are only limited by our imagination. This is why decolonizing our minds and emancipating our imagination is key to our liberation. We need to be thoroughly purged from centuries of psychosocial conditioning and internalized colonization grounded in European and American myths and lies of who we are, where we come from, our abilities, value, contributions to the world, and how our current state of affairs came to be. These lies were designed for us to internalize their delusion of superiority, even while they depended, and continue to depend, on our wealth, resources, intellect, skills, and labor to survive. We need to engage in individual and collective healing practices to address the cumulative trauma of coloniality, racism, patriarchy, ableism, capitalism, homo-transphobia and all intersecting systems of oppression that have been transmitted intergenerationally and experienced on the levels of the intrapersonal, interpersonal, institutional, systemic, and structural. Without healing from our own trauma, we are doomed to reproduce it among ourselves and reinforce the same systems of dominance in our problem-solving processes, which are then rendered impotent. Collective healing and restorative justice practices will provide us the courage to reject zero-sum, deficit-based, individualistic thinking taught to us by colonizers. Embracing collective action built on dynamic trusting relationships, weaving the physical and metaphysical, uncovering our stories of the past, present, future and in between, and integrating an ecocentric liberated ethos, empower us to reject old paradigms of being and create new ones. We will find that we do not fear or pathologize what others refer to as “complex”, but fondly accept and adapt to so-called complexities, while patiently massaging intersectional creative strategies that are rooted in our indigenous toolkits, ancestral wisdom, and youthful innovation. We will find that we can joyfully explore the beauty, abundance, and intricate multifariousness of our own humanities without parroting colonial stereotypes and unidimensional reductive analyses of our lived experiences and realities.
We will find ourselves liberated.
Global health will not survive its true decolonization. It is not supposed to. Instead, a better, transformed ecocentric world health system should emerge from the ashes of the deconstruction and dismantling of the global health industrial machine. We imagine a compassionate, intersectional, comprehensive, universal healthcare and public health system designed and led by the indigenous and unassimilable Majority people, and representing equity, justice, and liberation benefiting all and sundry.
The author acknowledges with gratitude that the land she lives and works on is the original homelands of the Anishinaabe: the Ojibwe, Odawa, and Botawatomi. She acknowledges the painful history of genocide and ongoing colonialism on this land of Detroit or Waawiyatanong and commits to honoring and respecting the diverse indigenous peoples, while learning how to be a better steward of the land.
Dr. Ijeoma Opara is a double-board certified Assistant Professor of Internal Medicine and Pediatrics at WSUSOM, Associate Program Director of the Internal Medicine-Pediatrics residency, and attending physician with Wayne State University Physician Group. She serves as a Section Editor for the Racism and Health Section of PLOS Global Public Health.